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Orchestration Of Columnar Lined Esophagus (CLE): Inflammatory Bowel Disease (IBD) Of The Esophagus

25.05.2010 by Reflux Medical

Riegler F. M.

European Surgery 2010; 42/2: 69-71.

Gastroesophageal reflux disease ( GERD) induces columnar lined esophagus (CLE), which may progress towards cancer via a sequence involving cardiac Mucosa, intestinal metaplasia (Barrett's esophagus) and Dysplasia.

Based on recent evidence the paper outlines our current understanding regarding the development of CLE and cancer.

CLE (±Barrett's esophagus, Dysplasia, cancer) is induced by gastroesophageal Reflux. Reflux in turn activates a neurohumoral orchestration within the Epithelium, which may end up in the formation of Dysplasia and cancer. Both, the Epithelium AND the subepithelial compartment (stroma+cells+mediators released from these cells) contribute to the development of genetic and morphologic changes leading to Barrett's and cancer formation.

It seems justified to eliminate the entire "neurohumoral flush" and the cause of the disease, the Reflux. Modalities to achieve this goal include radiofrequency ablation (HALO®, Barrx Medical, USA) and antireflux surgery. Proton pump inhibitor (PPI) therapy is essential for the normalization of the Epithelium after the ablation until Anti reflux surgery. The above algorithm requires Reflux monitoring before, during and after the therapies to assure the effect of the management and define the outcome based on function test data.

Taken together, CLE is to be considered as the inflammatory bowel disease of the esophagus, caused by Reflux.

Figure 3: Endoscopic image of columnar lined esophagus using Olympus NBI technology. This images has been taken in a patient with PPI sensitive GERD symptoms. (Olympus NBI endoscope).

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