DISCRETE ULCERS IN BARRETTS-ESOPHAGUS - RELATIONSHIP TO ACUTE GASTROINTESTINAL-BLEEDING

Background and Study Aims: Although discrete ulcers are a recognized c omplication of Barrett's esophagus, it is not dear how common discrete ulceration is in Barrett's mucosa. Furthermore, the relationship of g astrointestinal hemorrhage to Barrett's ulceration is unknown. These i ssues were investigated in this paper. Methods: Seventy-eight patients with histologically confirmed Barrett's esophagus were monitored by e ndoscopic surveillance over 1 to 11 years (mean 3.3 years). The incide nce of a Barrett's ulcer was noted and its site recorded. The frequenc y of gastrointestinal hemorrhage at diagnosis or on follow-up was docu mented and the source of the bleeding was identified. Results: Discret e ulcers were identified in 36 of 78 patients (46 %) at some time over the period of follow-up. Eight patients had two or more ulcers. Most of ulcers were in the distal esophagus; 86 % of these were within 3 cm of the anatomic gastroesophageal junction. Nineteen patients (24 %) e ither presented with active gastrointestinal bleeding or had bleeding at follow-up. In 15 of the 19 patients with bleeding (79 %) a discrete Barrett's ulcer was the source of the hemorrhage. Conclusions: Ulcera tion is a common complication of Barrett's esophagus. These ulcers are usually located close the gastroesophageal junction and have a high i ncidence of bleeding.