High-grade dysplasia in patients with Barrett esophagus

High-grade dysplasia in Barrett esophagus (also known as Barrett esophagus with high-grade dysplasia) is a precancerous condition affecting the esophagus, the muscular tube that connects the throat to the stomach. Barrett esophagus occurs when the normal squamous epithelial lining of the lower esophagus is replaced by specialized intestinal-type columnar epithelium (a process called intestinal metaplasia), typically as a consequence of chronic gastroesophageal reflux disease (GERD). High-grade dysplasia represents the most advanced stage of precancerous cellular changes within this metaplastic tissue, indicating that the cells have acquired significant abnormalities in size, shape, and organization, placing the patient at substantially elevated risk for progression to esophageal adenocarcinoma. Patients with this condition may experience symptoms related to underlying GERD, including chronic heartburn, acid regurgitation, difficulty swallowing (dysphagia), and chest discomfort. However, the dysplasia itself is often asymptomatic and is typically detected through endoscopic surveillance with biopsy in patients already known to have Barrett esophagus. Risk factors include long-standing GERD, obesity, male sex, Caucasian ethnicity, tobacco use, and older age. Management of high-grade dysplasia in Barrett esophagus has evolved significantly. Current treatment options include endoscopic therapies such as radiofrequency ablation (RFA), endoscopic mucosal resection (EMR), and cryotherapy, which aim to eradicate the dysplastic tissue while preserving the esophagus. Esophagectomy (surgical removal of part of the esophagus) was historically the standard of care but is now generally reserved for cases where endoscopic treatment fails or where invasive carcinoma is suspected. Proton pump inhibitor therapy is used to control acid reflux and may help reduce further progression. Regular endoscopic surveillance remains essential for monitoring treatment response and detecting recurrence.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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