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Barrett-Ösophagus: Epidemiologie, Karzinomhäufigkeit, Screening-Notwendigkeit

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Im Barrett-Ösophagus wird das für die Speiseröhre typische Plattenepithel durch Zylinderepithel ersetzt. Ursache hierfür ist der für die Refluxkrankheit charakteristische Reflux von Säure und Galle. Das Zylinderepithel weist eine spezialisierte intestinale Metaplasie auf, die ein malignes Potenzial besitzt und zum Adenokarzinom des distalen Ösophagus prädispondiert, dessen Inzidenz in den letzten 3 Jahrzehnten stetig zunimmt. Seine Entstehung aus einem Barrett-Ösophagus ist gut belegt. Davon ist das Kardiakarzinom abzugrenzen, das aus dem Zylinderepithel der Kardia seinen Ausgangspunkt nimmt. Auch seine Häufigkeit nimmt zu, wenn auch weniger ausgeprägt. Ein Barrett-Ösophagus liegt bei etwa 3–5% der Patienten mit Refluxkrankheit vor. Das Risiko, in einem Barrett-Ösophagus ein Karzinom zu entwickeln, ist um etwa das 40fache gegenüber gesunden Kontrollen erhöht. Da der Barrett-Ösophagus somit als prämaligne Veränderung gilt, wäre die frühzeitige Erkennung diesen Patienten wünschenswert, um gezielte Überwachungsprogramme durchzuführen. Der Nutzen eines Screeningprogrammes wird jedoch bei hoher Prävalenz der gastroösophagealen Refluxkrankheit und gleichzeitig geringer Zahl von Patienten mit Barrett-Ösophagus und typischen Refluxbeschwerden kontrovers diskutiert. Gleichwohl empfehlen die einschlägigen Fachgesellschaften ein risikoadaptiertes endoskopisches Überwachungsprogramm.

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  1. R. Arnold

    Present address: Klinikum der Philipps-Universität, Klinik für Innere Medizin, Gastroenterologie,Stoffwechsel und Endokrinologie , Baldingerstraße, 35043 , Marburg

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  1. Klinik für Innere Medizin, Philipps-Universität Marburg

    R. Arnold & M. Wied

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Arnold, R., Wied, M. Barrett-Ösophagus: Epidemiologie, Karzinomhäufigkeit, Screening-Notwendigkeit. Internist 44, 43–51 (2003). https://doi.org/10.1007/s00108-002-0813-4

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