Under metaplasia is understood the replacement of one type of cell with another in the mucous membrane of a particular organ. When the pathological process is localized in the esophagus, multilayer flat epithelial cells are replaced by cylindrical cells that are characteristic in the normal state for the gastric mucosa.
Pathology Description
Barrett's metaplasia and esophagus are one and the same. There is an ailment quite often among the pathologies of this organ. Metaplasia can be a complication of the inflammatory process or a harbinger of cancer. The most susceptible to the development of esophageal metaplasia are men aged 55 years.
The structure of the mucosa
The histological structure of the mucous membrane of the stomach and esophagus is different. The walls of the esophagus are lined with a stratified squamous epithelium. Organ cells have a flattened shape and are located in the esophagus in several layers.
What is the epithelium?
The epithelium of the stomach is a collection of cylindrical cells. They are called a single-layer cylindrical epithelium. Against the background of prolonged irritation of the mucous membrane of the esophagus with gastric juice, for example, with gastroesophageal reflux, when the contents of the stomach are thrown into the esophagus, the risk of developing a gastric variant of esophageal metaplasia increases.
The essence of the disease is to replace the stratified squamous epithelium of the esophagus with a single-layered cylindrical, characteristic of the stomach. The part of the esophagus in which the mucous membrane of the organ passes into the stomach is most affected by tissue replacement. It is in the area of the union of the two organs that the most intense irritation with hydrochloric acid occurs against the background of gastroesophageal reflux.
Focal and diffuse metaplasia
In addition, such forms of esophageal metaplasia as diffuse and focal are distinguished. The latter is characterized by the replacement of certain tubular glands that occurs as a result of the inflammatory process or the renewal of cells of the gastrointestinal tract. Diffuse metaplasia is determined by the defeat of the mucous membrane of the stomach and esophagus without the death of cells and tissue structures.
Risk factors
Esophageal cylindrocellular metaplasia occurs under the influence of the same provoking factors that lead to the appearance of gastroesophageal reflux disease. Specialists identify the following risk factors:
- Decreased tone of the esophagus sphincter in the lower part. This is due to insufficient innervation, when the sphincter is not tightly compressed and gastric juice is thrown back into the esophagus.
- Changes in the structure of the congenital type. Under the influence of genetic factors, an increase or decrease in the diameter of the lower part of the esophagus sphincter occurs.
- Inflammatory processes transferred earlier. Localized in the lower part of the esophagus, similar processes provoke the appearance of scars in the organ and lead to incomplete compression of the sphincter.
- Severe varicose veins. In this case, it is the nodes formed during varicose veins that prevent the sphincter from completely closing.
- Disorder of the motor-evacuation function of the stomach and esophagus. Against the background of such a violation, antiperistaltics is observed when the walls of the organs begin to move, leading to the movement of food masses into the upper sections of the esophagus.
These factors are capable of provoking the appearance of gastroesophageal reflux, which in turn can cause gastritis of the erosive type, which later develops into gastric and intestinal metaplasia of the esophagus.
Symptoms
Many are interested in how the disease manifests itself?
If we are talking about focal metaplasia of the esophagus, then the clinical manifestations of this disease, as a rule, are not observed. Suspicion of metaplasia occurs with clinical manifestations of gastroesophageal reflux. Therefore, we can say that the signs of disease coincide and are as follows:
- Frequent heartburn. A strong burning sensation occurs in the sternum region, provoked by irritation of the esophagus epithelial layer by the contents of the stomach during reverse casting.
- Sour burp. Most often it is the forerunner of heartburn. Belching occurs after eating or while tilting the body.
- Soreness in the sternum. The intensity of the pain syndrome increases on an empty stomach and has the property of irradiating a region of the neck, lower jaw and left half of the chest, as well as into the space between the shoulder blades.
- Extraesophageal symptoms. This can be shortness of breath, coughing, dryness and sore throat, hoarseness, feeling as if the stomach is full even after a small amount of food.
When these signs appear, one should examine for the presence of foci of metaplasia of the gastric mucosa into the esophagus and determine their vastness and severity.
Complications
Replacing the esophagus with a single layer of cylindrical epithelium can cause a number of serious complications, including:
- Transformation of metaplasia foci into malignant neoplasms. The most common cancer of the esophagus in the form of adenocarcinoma.
- Hemorrhagic syndrome, localized in the foci of metaplasia and damage to the esophagus.
- The appearance of peptic strictures. These are adhesions from connective tissues that narrow the lumen of the esophagus in the place of their localization and provoke the development of dysphagia, which consists in disrupting the process of swallowing food.
To prevent such complications, it is important to diagnose metaplasia in time and receive appropriate treatment aimed at reducing the size of the foci and their number.
Diagnostics
The diagnosis of cylindrical esophageal metaplasia is made only on the basis of an instrumental examination of the patient. Modern medicine uses several methods at once that allow you to visualize the mucous membrane of the esophagus, including:
- Esophagoscopy An instrument called an endoscope is introduced into the lumen of the organ, which is a tube made of fiber optic, equipped with lighting and a camera. The doctor can assess the condition of the mucous membrane of the esophagus by receiving an image from the endoscope on a special monitor. To obtain a more detailed image of metaplasia, a contrast agent is used to highlight the foci of the pathological process. Thus, it is possible to establish the presence of an oncological neoplasm and detect metaplasia at the initial stage of development.
- Target biopsy. It is carried out along with the previous diagnostic method. Esophagoscopy determines the exact location of the foci of metaplasia, which allows you to take tissue for histological examination specifically from the affected area. A specialist in a laboratory examines the resulting sample, determining the presence of a single-layer cylindrical epithelium in the composition of the esophageal tissue.
- X-ray examination. Helps visualize the structure of the walls of the esophagus and evaluate its motor-evacuation ability. This method also uses a contrast agent introduced into the lumen of the esophagus.
- Manometry. It is carried out by measuring the pressure in the esophagus lumen.
- Impedanceometry Study of the motor-evacuation ability of all departments of the esophagus.
After a thorough examination and clarification of the diagnosis, the doctor prescribes treatment for metaplasia.
Treatment: general principles
The main principles of the treatment of esophageal metaplasia are the elimination and reduction of the size of foci of a single-layer cylindrical epithelial layer in the mucous membrane of the esophagus. The therapy is carried out comprehensively and includes both conservative treatment and surgical methods, and general recommendations on nutrition and lifestyle.
An important step in the treatment of gastric metaplasia of the esophagus is experts consider the implementation of general recommendations that can stop the symptoms of pathology. In addition, compliance with the following rules enhances the effectiveness of other treatments:
- Maintaining a balanced diet. Hot and cold dishes, as well as fried, fatty, smoked foods, marinades, pickles and spices, are subject to exclusion.
- Support for proper diet. Eat at least five times a day in small portions. The final meal should be no less than two hours before bedtime. We must try not to lie after eating.
- Bringing body weight back to normal, provided it is deficient or in excess.
- Quitting bad habits, including alcohol and smoking. Such habits contribute to even more irritation of the mucous membrane of the esophagus and increase the risk of increasing foci of the disease.
- Physical activity should be moderate. Weight lifting should be excluded, as this increases the risk of developing pressure within the peritoneum.
These rules will increase the effectiveness of the treatment and prevent surgery, eliminating small foci of gastric metaplasia of the esophagus mucosa.
Drug treatment
Conservative treatment of esophageal metaplasia involves the use of drugs whose action is aimed at reducing the number of refluxes of gastric juice into the esophagus. For this purpose, specialists prescribe the following groups of medicines to patients:
- Antacids. The effect of these drugs is to reduce the acid properties of gastric juice. Antacids include Maalox, Almagel, Fosfalugel, etc.
- Proton pump blockers. These drugs inhibit the production of hydrochloric acid. The most popular drug of this group for esophageal metaplasia is Omeprazole.
- H1-histamine receptor blockers. Also used to reduce the amount of acid produced. Most often, Famotidine is prescribed.
- Prokinetics. These drugs have a stimulating effect on the motility of the stomach and esophagus, which prevents the throwing of food mass into the upper digestive system. One of the prominent representatives of this group of medicines is Motilium.
The blockers mentioned above are prescribed only after checking the acidity of the gastric juice, as well as determining the intensity of its peristalsis. It is possible to treat with medication only foci of metaplasia of the esophagus epithelium of a small size.
Surgery
This is a radical treatment option and is considered a last resort. Surgeons use several techniques to remove esophageal metaplasia, including:
- Open access operation. This is a traumatic manipulation when a dissection of the chest is performed and the affected part of the esophagus is removed. The operation is prescribed in cases of extensive damage to the esophagus by foci of metaplasia.
- Fundoplication. This operation is also performed with open access, however, during fundoplication, the gastric fundus is sutured to the diaphragm. Thus, it is possible to form an acute angle with the esophagus and reduce the reflux of gastric juice into the organ.
- Laser Therapy This is a more modern method than abdominal surgery. Using a low-frequency laser, a single-layer cylindrical epithelial layer is destroyed in the area of metaplasia formation.
- Photodynamic therapy. The foci of metaplasia are destroyed by introducing a special photochemical element into them. Further, the substance is exposed to light of a certain wave, which leads to the death of unnecessary cells.
Postoperative period
In the postoperative period with esophageal mucosal metaplasia, you must continue to adhere to general recommendations on nutrition and lifestyle. This will prevent a relapse of the disease.