Dijagnostički pristup i liječenje Barretovog jednjaka

master's thesis

• Title (english): Diagnostic approach and treatment of Barrett's esophagus
• Author: Tihana Pecotić
• Mentor: Tajana Filipec Kanižaj (mentor)
• Committee member: Nikola Sobočan (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Tajana Filipec Kanižaj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Barretov jednjak (BE) je patohistološka dijagnoza koja označava metaplaziju
višeslojnog pločastog epitela u cilindrični epitel s vrčastim stanicama. Javlja se kao
komplikacija gastroezofagealne refluksne bolesti (GERB). BE se smatra
prekancerozom jer postoji rizik od progresije u adenokarcinom jednjaka (EAC). BE
nalazimo u 5 do 15% simptomatskih bolesnika sa GERB-om te u 1,3 do 1,6% opće
populacije. Glavni rizični čimbenici za razvijanje BE-a su: učestalost i duljina trajanja
simptoma GERB-a, konzumiranje duhana, centralna pretilost i hijatalna hernija.
Prevalencija je povezana sa starijom dobi muškim spolom i bijelom rasom. Godišnji
rizik od progresije u EAC iznosi 0,12%, dok 5-godišnje preživljenje je vrlo loše te ne
prelazi 20%.Danas najprihvaćenija teorija nastanka BE je da se oštećeni višeslojni
pločasti epitel zamjenjuje sa progenitornim stanicama gastroezofagealnog spoja koje
proliferiraju, prolaze epitelno mezenhimalnu tranziciju (EMT) i migriraju proksimalno u
jednjak.Metaplazija ne uzrokuje kliničke simptome, većina pacijenata javlja se liječniku
zbog simptoma povezanih sa GERB-om. Dijagnoza BE-a se postavlja kada su
zadovoljena dva kriterija: endoskopski nalaz cilindričnog epitela od barem 1cm duljine
u distalnom dijelu jednjaka i patohistološka potvrda intestinalne metaplazije s vrčastim
stanicama iz tog uzorka. Metoda izbora za dijagnozu i praćenje je visokorezolucijski
endoskop s bijelim svijetlom (HD-WLE) pomoću kojeg određujemo veličinu segmenta
BE-a prema validiranim Praškim C&M kriterijima. Zbog varijabilne raspodjele vrčastih
stanica unutar BE, uveden je Seattle protokol koji podrazumijeva uzimanje uzoraka za
biopsiju svakih 1-2 cm u četiri kvadranta uz ciljane biopsije na makroskopskim vidljivim
dijelovima sluznice. U liječenju BE-a koristi se farmakoterapija IPP-om, endoskopsko
te kirurško liječenje.Endoskopsko liječenje uključuje resekciju suspektne sluznice i
ablaciju preostale sluznice BE-a. Kirurško liječenje ezofagektomijom, koja je
popraćena sa značajnim mortalitetom i morbiditetom, je indicirano samo u slučaju
submukozne invazije.

Abstract (english)

Barrett's esophagus (BE) is a patohistological diagnosis in which metaplastic columnar
epithelium replaces the stratified squamous epithelium and occurs as a complication
of gastroesophageal reflux disease (GERD). BE is considered a precancerous
condition because of the risk of developing esophageal adenocarcinoma (EAC). BE is
found in 5% to 15% of symptomatic GERD patients and in 1.3% to 1.6% of the general
population. The main risk factors for developing BE are: frequency and duration of
GERD symptoms, tobacco use, central obesity, and hiatal hernia. Prevalence is
associated with older age, male gender, and white race. The annual risk of progression
to EAC is 0.12%, while the 5-year survival rate is very low and does not exceed 20%.
The most accepted theory of the development of BE is that the damaged multilayered
squamous epithelium is replaced by gastroesophageal transition progenitor cells,
which proliferate, undergo epithelial-mesenchymal transition (EMT), and migrate
proximally into the esophagus. Metaplasia does not cause clinical symptoms, and most
patients seek medical attention for GERD-related symptoms. The diagnosis BE is
made when two criteria are met: endoscopic finding of a cylindrical epithelium at least
1 cm long in the distal part of the esophagus and pathohistologic evidence of intestinal
metaplasia with goblet cells from this specimen. For diagnosis and follow-up we use
the high-resolution white-light endoscope (HD-WLE), with which we determine the size
of the segment BE according to the validated Prague C&M criteria. Due to the variable
distribution of goblet cells within BE, we adopted the Seattle protocol of taking biopsy
samples every 1-2 cm in four quadrants with targeted biopsies at macroscopically
visible parts of the mucosa. Treatment of BE includes pharmacotherapy with PPI,
endoscopic therapy, and surgery. Endoscopic treatment consists of resection of the
suspicious mucosa and ablation of the remaining BE mucosa.Surgical treatment with
esophagectomy is indicated only in cases of submucosal invasion, as it is associated
with significant mortality and morbidity.

• Keywords: gastroezofagealna refluksna bolest; Barretov jednjak; displazija; endoskopska terapija; ezofagektomija
• Keywords (english): gastroesophageal reflux disease; Barrett's esophagus; dysplasia; endoscopic therapy; esophagectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:794006
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-26 10:14:55