BARRETTS-ESOPHAGUS AFTER CONTINUOUS 5-FLUOROURACIL INFUSION - A CASE-REPORT

Barrett's esophagus is suspected to be sometimes a consequence of long -term chemotherapy. A 61-year-old man with liver metastases from colon cancer, treated with continuous 5-fluorouracil (5-FU) infusion starti ng from April 1995, developed acute haematemesis in August 1995, Esoph agogastroduodenoscopy (EGDS) showed bleeding ulcerations of the esopha gus; the distal esophagus was red stained with blood, and Z-line was n ot evaluable, EGDS was repeated after 2 weeks, showing the Z-line loca ted 6 cms above the lower esophageal sphincter. Biopsies showed gastri c fundic-type epithelium. Before starting chemotherapy, the patient ha d undergone EGDS, and no esophageal abnormality was observed. 5-FU is known to cause mucosal erosions that may extend throughout the esophag us. The continuous infusion might have provoked extensive destruction of the squamous epithelium, with re-epithelialization by undifferentia ted stem cells, and successive differentiation into cell types charact eristic of Barrett's epithelium.