Differences in the Characteristics of Barrett's Esophagus and Barrett's Adenocarcinoma between the United States and Japan

Abstract

In Europe and the United States, the incidence of esophageal adenocarcinoma has increased 6-fold in the last 25 years and currently accounts for more than 50% of all esophageal cancers. Barrett's esophagus is the source of Barrett's adenocarcinoma and is characterized by the replacement of squamous epithelium with columnar epithelium in the lower esophagus due to chronic gastroesophageal reflux disease (GERD). Even though the prevalence of GERD has recently been increasing in Japan as well as in Europe and the United States, the clinical situation of Barrett's esophagus and Barrett's adenocarcinoma differs from that in Western countries. In this paper, we focus on specific differences in the background factors and pathophysiology of these lesions.

Figure 1

(a) The esophagogastric junction was diagnosed in the upper end of the gastric fold and the lower end of the palisade vessels. Palisade vessels can be found in the Barrett esophagus. (b) Barrett esophagus by magnifying endoscpy and narrow band Imaging (NBI) observation.

Figure 2

Histopathological findings of the resected specimen (low-power view). Low-power view shows the remained squamous epithelium, specialized columnar epithelium, and esophageal gland or duct.

Figure 3

(a) Squamous columnar junction is located at 29 cm from the incisors. (b) Mucosal changes are seen in the entire circumference of pale redness and rough from squamous columnar junction to upper end of the gastric fold. (c) and (d) Endoscopic view revealed a reddish protruded lesion with an uneven surface located at 1 o'clock position in the oral side of Barrett's esophagus after the spreading of indigo carmine.

Figure 4

Histopathological findings of the resected specimen (low-power view). Pathological diagnosis shows Barrett's adenocarcinoma close to squamous epithelium.