Barrett Özofagusu
Özet
Barrett Özofagusu (BÖ), kronik hasar sonucu özefagusun normal skuamöz mukozasının metaplastik kolumnar epitele dönüşmesidir. Gastroözofageal reflü hastalarında daha sık görülen bu durum, özofagus adenokarsinomunun öncül lezyonu olması nedeniyle klinik açıdan büyük önem taşır. BÖ tanısı, endoskopik olarak somon renginde görülen mukozadan alınan biyopsilerin histopatolojik incelenmesi ve intestinal metaplazinin gösterilmesiyle konur. Risk faktörleri arasında 50 yaş üzeri olmak, erkek cinsiyet, beyaz ırk, sigara kullanımı, obezite ve kronik reflü yer alır. Kesin tanı için gold standart yöntem sedasyon altında yapılan endoskopik biyopsidir; ayrıca transnazal endoskopi ve bağlı kapsül endomikroskopi gibi alternatif yöntemler de mevcuttur. Maligniteye ilerleme riski nedeniyle hastalar displazi derecesine göre düzenli endoskopik takibe (sürveyans) alınır. Medikal tedavinin temelini, asit baskılayıcı ve antiinflamatuar özellikleri olan proton pompa inhibitörleri (PPI) oluşturur. Displazi saptanan vakalarda ise Endoskopik Mukozal Rezeksiyon (EMR), Endoskopik Submukozal Rezeksiyon (ESD) gibi eksizyonel yöntemlerin yanı sıra en sık tercih edilen ablasyon seçeneği olan Radyofrekans Ablasyon (RFA) ve alternatif olarak kriyoterapi uygulanır. Cerrahi tedavi yalnızca altta yatan gastroözofageal reflü varlığında tercih edilir.
Barrett's Esophagus (BE) is the transformation of the normal squamous esophageal mucosa into metaplastic columnar epithelium due to chronic injury. More common in patients with gastroesophageal reflux, this condition carries high clinical significance as a precursor lesion to esophageal adenocarcinoma. The diagnosis of BE is established through histopathological examination of biopsies obtained from salmon-colored mucosa during endoscopy, confirming intestinal metaplastic presence. Risk factors include being over 50, male gender, Caucasian race, smoking, obesity, and chronic reflux. The gold standard diagnostic method is endoscopic biopsy under sedation; alternative methods like transnasal endoscopy and tethered capsule endomicroscopy are also available. Due to the risk of malignant progression, patients undergo regular endoscopic surveillance based on their dysplasia grade. Medical treatment relies fundamentally on proton pump inhibitors (PPIs) for acid suppression and anti-inflammatory benefits. In dysplastic cases, excisional methods such as Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Resection (ESD) are utilized, alongside Radiofrequency Ablation (RFA) as the primary ablation option, and cryotherapy as an alternative. Surgical treatment is considered exclusively for managing underlying gastroesophageal reflux disease.
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