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Ann Thorac Surg 1982;33:19-27
© 1982 The Society of Thoracic Surgeons

Articles

Extended and Limited Types of Barrett's Esophagus in the Adult

John M. Ransom, M.D., Ganesh K. Patel, M.D., Steven A. Clift, M.D., Nolan E. Womble, B.S., Raymond C. Read, M.D.*

From the Departments of Surgery and Medicine, Veterans Administration Medical Center and University of Arkansas for Medical Sciences, Little Rock, AR.

* Address reprint requests to Dr. Read, Department of Surgery, VA Medical Center, 300 E Roosevelt Rd, Little Rock, AR 72206.

Columnar epithelium–lined lower esophagus (CLLE) or Barrett's esophagus was found in 34 patients diagnosed by endoscopic biopsy. In one-half of them, the CLLE extended up to 30 cm from the incisors (limited group) and in the other half, it reached above this level (extended group). Eight patients with stricture and limited CLLE had the lesion in the lower third of the esophagus, whereas 6 of 8 with strictures in the extended group had narrowing in the upper third of the esophagus. Two other patients with extended CLLE were seen with bleeding from Barrett's ulcer, 3 had adenocarcinoma, and the remaining 4 had CLLE without these complications.

The three classic histological types were encountered in both groups. However, in the extended group there was more of the intestinal type and less of the junctional type of epithelium, the latter being seen mostly in the limited group. The extended group had very low lower esophageal sphincter (LES) pressures (mean, 7.3 mm Hg) with severe reflux. The limited group had a higher mean LES pressure (11.2 mm Hg) with less severe reflux. In both groups, LES pressure and reflux improved following effective antireflux operation; some patients had regression of CLLE. In some patients who continued to have demonstrable reflux and a lack of improvement in LES pressure despite antireflux operation, the disease progressed, as evidenced by extension of CLLE.




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