Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Enhanced Imaging of the Esophagus: Confocal Laser Endomicroscopy

9.1 Introduction Barrett’s esophagus (BE) is associated with the risk of development of esophageal adenocarcinoma. Current surveillance according to the Seattle protocol includes white light endoscopy (WLE) with the collection of random four-quadrant biopsy specimens over every 1–2 cm of the columnar-lined esophagus. The aim of such surveillance is detection of neoplasia, ideally at an (endoscopically) curable stage. This state-of-the-art approach is labor intensive and prone…

Enhanced Imaging of the Esophagus: Optical Coherence Tomography

8.1 Introduction Optical coherence tomography (OCT) is an optical analog of ultrasound imaging that was invented in the early 1990s . OCT fills a resolution gap between confocal laser endomicroscopy (CLE) and ultrasound, affording the capability of visualizing architectural microscopic morphology at a resolution of approximately 10 µm and to a depth of several millimeters (mm). OCT is also advantageous in that it provides cross-sectional images…

In Vivo Optical Detection of Dysplasia in Barrett’s Esophagus with Endoscopic Light Scattering Spectroscopy

7.1 Introduction The incidence of adenocarcinoma of the esophagus is increasing more rapidly than any other type of carcinoma in the United States . Almost 100% of cases occur in patients with Barrett’s esophagus (BE) , a benign condition in which metaplastic columnar epithelium replaces the normal squamous epithelium of the esophagus. Although the prognosis of patients diagnosed with adenocarcinoma is poor, the chances of successful…

Screening and Surveillance of Barrett’s Esophagus

6.1 Overview Five decades after the British surgeon Norman Barrett first described the condition that bears his name, the true incidence of Barrett’s esophagus (BE) in the general population and the risk of progression to cancer continue to be areas of uncertainty, debate, and controversy . While the pathologic definition of BE has evolved over time, our current screening and surveillance recommendations are based in large…

Diagnosis of Barrett’s Esophagus

5.1 Introduction In 1950, Norman Barrett wrote the paper entitled “Chronic peptic ulcer of the oesophagus and ‘oesophagitis’” where he described a case in which a portion of the stomach was noted to be within the chest . It was later determined by Allison and Johnstone in a detailed description of seven cases that what Barrett had described was actually a columnar-lined esophageal segment. They also…

Genetics and Biomarkers in Barrett’s Esophagus and Esophageal Adenocarcinoma

4.1 Introduction Barrett’s esophagus (BE) is the premalignant lesion for esophageal adenocarcinoma (EAC): a malignancy with a very poor prognosis. The progression of BE from benign columnar-lined epithelium (CLE) to adenocarcinoma often occurs through a series of dysplastic stages termed low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Recent evidence suggests a benefit for treating patients with dysplasia in order to prevent progression to adenocarcinoma. However, this…

Metaplasia and Dysplasia in Barrett’s Esophagus

3.1 Introduction Barrett’s esophagus (BE) occurs in the setting of chronic gastroesophageal reflux disease (GERD). It is characterized by conversion of the normal esophageal squamous epithelium into metaplastic columnar epithelium . Since its original description by Tileston et al. there have been several alterations of this definition. It is now widely accepted that BE is an alteration of the esophageal mucosa that is visible endoscopically and…

Fluctuating Risk Factors and Epidemiology

2.1 Introduction The first description of Barrett’s esophagus (BE) is attributed to Sir Norman Barrett in 1950 who reported ulcerations in the tubular segment of stomach that had been tethered within the chest by a congenitally short esophagus . By the 1970s, it had been accepted that BE is an acquired condition associated with severe gastroesophageal reflux disease (GERD) and has a malignant predisposition . The…

A Disease Entity Is Identified

1.1 Introduction Barrett’s esophagus (BE) is the presence of metaplastic columnar epithelium in the lower portion of the esophagus, which is normally lined with stratified squamous epithelium. The main cause of the disease is theorized to be reflux esophagitis developed due to chronic acid exposure as a result of symptomatic or asymptomatic gastroesophageal reflux. In addition, the disease is clinically significant as a major risk factor…

Macroscopic examination of surgically resected specimens in inflammatory bowel disease

Abbreviations CD Crohn’s disease GI gastrointestinal IBD inflammatory bowel disease IPAA ileal pouch–anal anastomosis ITB intestinal tuberculosis UC ulcerative colitis Introduction Inflammatory bowel disease (IBD) exemplified by Crohn’s disease (CD) and ulcerative colitis (UC) describes chronic inflammatory conditions of the gastrointestinal (GI) tract characterized by intermittent relapse and remission. Although the precise etiology remains unclear, it is believed to arise in genetically susceptible individuals exposed to…

Endoscopic evaluation of bezoars and foreign bodies in inflammatory bowel diseases

Abbreviations CD Crohn’s disease IBD inflammatory bowel disease IPAA ileal pouch–anal anastomosis UC ulcerative colitis Introduction Bezoars in the gastrointestinal tract are accumulated indigestible foreign materials, which can produce concretions. According to their compositions, Bezoars have been classified into following types: (1) phytobezoars (vegetable or fruit fibers), (2) lactobezoars (milk or dairy proteins), (3) trichobezoars (hairs), (4) lithobezoars (calcified, stone-like materials), and (5) pharmacobezoars (medications) .…

Inflammatory bowel disease–associated bleeding

Abbreviations CD Crohn’s disease GI gastrointestinal IBD inflammatory bowel disease UC ulcerative colitis Introduction Bloody bowel movement is a common presentation of active ulcerative colitis (UC). In contrast, brisk bleeding in Crohn’s disease (CD) is uncommon. Rather, patients with CD often present with iron-deficiency anemia or anemia of chronic disease. The patterns of gastrointestinal (GI) hemorrhage in inflammatory bowel disease (IBD) ranges from obscure bleeding to…

Transmural endoscopic imaging in inflammatory bowel disease

Abbreviations CD Crohn’s disease IBD inflammatory bowel disease EUA examination under anesthesia EUS endoscopic ultrasound MRI magnetic resonance imaging OCT optical coherence tomography Introduction Endoluminal imaging plays a crucial role in the primary diagnosis and management of patients with inflammatory bowel disease (IBD). Advances in the field of ultrasonography and fiber optics have enhanced the ability to assess the gastrointestinal tract transmurally. This chapter provides an…

Histology correlation with common endoscopic abnormalities

Abbreviations AFB acid-fast bacillus AIC acute infectious colitis AIE autoimmune enteropathy CD Crohn’s disease DALM dysplasia-associated lesion or mass EMR endoscopic mucosal resection GI gastrointestinal GVHD graft-versus-host disease IBD inflammatory bowel disease ITB intestinal tuberculosis NSAIDs Nonsteroidal antiinflammatory drugs SRUS solitary rectal ulcer syndrome TNF tumor necrosis factor UC ulcerative colitis Introduction Reaching an accurate diagnosis of inflammatory bowel disease (IBD) requires the synthesis of clinical,…

Inflammatory bowel disease–like conditions: gastrointestinal lymphoma and other neoplasms

Abbreviations CCS Cronkhite–Canada syndrome CD Crohn’s disease DLBL diffuse large B-cell lymphoma EATL enteropathy-associated T-cell lymphoma FAP familial adenomatous polyposis H & E hematoxylin-Eosin HNPCC hereditary nonpolyposis colorectal cancer IBD inflammatory bowel disease LPD lymphoproliferative disorders MALT mucosa-associated lymphoid tissue MCL mantle cell lymphoma NK natural killer NET neuroendocrine tumor NHL non-Hodgkin’s lymphoma PGIL primary gastrointestinal lymphoma PJS Peutz–Jeghers syndrome UC ulcerative colitis Introduction The incidence…

Inflammatory bowel disease–like conditions: miscellaneous

Abbreviations CD Crohn’s disease CSC cat scratch colon EGID eosinophilic gastrointestinal disorders CMUSE cryptogenic multifocal ulcerous stenosing enteritis IBD inflammatory bowel disease UC ulcerative colitis Introduction A long list of conditions can present inflammation or ulcers or strictures in the gastrointestinal (GI) tract. These conditions include eosinophilic GI disorders (EGID), cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), sclerosing mesenteritis, diverticular colitis, and rectal prolapse. They mimic inflammatory…

Inflammatory bowel disease–like conditions: monogenic gastrointestinal disorders

Abbreviations CD Crohn’s disease GI gastrointestinal IBD inflammatory bowel disease IL10RA interleukin 10 receptor-α IPEX immune dysregulation, polyendocrinopathy, enteropathy, X-linked LRBA LPS-responsive beige-like anchor protein VEOIBD very early–onset inflammatory bowel disease Introduction Very early–onset inflammatory bowel disease (IBD) (VEOIBD) refers to patients who have onset of disease before 6 years of age . The majority of patients in this group have monogenic defects. To date, there…

Inflammatory bowel disease–like conditions: immune deficiencies

Abbreviations CD Crohn’s disease CVID common variable immune deficiency GI gastrointestinal IBD inflammatory bowel disease Ig immunoglobulin IVIG intravenous immunoglobulin SIgAD selective IgA deficiency UC ulcerative colitis Introduction Primary or secondary immune defects can occur in both children and adults. Primary immune defects are mainly seen in pediatric patients. In contrast, immune defects in adults often result from secondary causes. Secondary immune disorders can be caused…

Inflammatory bowel disease–like conditions: medication-induced enteropathy

Abbreviations 5-FU 5-fluorouracil ACEIs angiotensin-converting enzyme inhibitors CD Crohn’s disease CMV cytomegalovirus COX cyclooxygenase CTLA-4 anticytotoxic T-lymphocyte-association protein-4 GI gastrointestinal IBD inflammatory bowel disease ICIs immune checkpoint inhibitors MMF mycophenolate mofetil NSAIDs nonsteroidal antiinflammatory drugs OAE olmesartan-associated enteropathy PD-1 programmed cell death protein-1 PERT pancreatic enzyme replacement therapy SPS sodium polystyrene sulfonate Introduction Many conditions may share the clinical and endoscopic features of inflammatory bowel disease…

Inflammatory bowel disease–like conditions: ischemic bowel diseases and vasculitides

Abbreviations ANCA antineutrophil cytoplasmic antibody BD Behçet disease CD Crohn’s disease CT computed tomography EGPA eosinophilic granulomatosis with polyangiitis IBD inflammatory bowel disease GI gastrointestinal Ig immunoglobulin PAN polyarteritis nodosa SLE systemic lupus erythematosus UC ulcerative colitis Introduction Diagnosis and differential diagnosis of inflammatory bowel disease (IBD) are important for the management and prognosis. Among mimics of IBD a group of diseases with underlying ischemia, vasculitis,…