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Barrett syndrome

Barrett's esophagus refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis. Barrett's esophagus is found in about 10% of patients who seek medical care for heartburn (gastroesophageal reflux). It is considered to be a premalignant condition and is associated with an increased risk of esophageal cancer. more...

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The condition is named after Dr Norman Barrett (1903-1979), Australian-born British surgeon at St Thomas' Hospital, who described the condition in 1957.


Current recommendations include routine endoscopy and biopsy (looking for dysplastic changes) every 12 months or so while the underlying reflux is controlled with H2 antagonists or proton pump inhibitor drugs in combination with measures to prevent reflux. In severe dysplasia, laser treatment is being used, whereas overt malignancy may require surgery, radiation therapy, or systemic chemotherapy. There is presently no reliable way to determine which patients with Barrett's esophagus will go on to develop esophageal cancer.


Barrett's esophagus is marked by the presence of columnar cell epithelium in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased cancer risk of the adenocarcinoma type.

The metaplastic columnar cells may be of two types: gastric (similar to those in the stomach) or colonic (similar to cells in the intestines). A biopsy of the affected area will often contain a mixture of the two. Colonic-type metaplasia confers a higher risk of malignancy.

The metaplasia of Barrett's esophagus is visible grossly through a gastroscope, but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature.


  • Barrett NR. The lower esophagus lined by columnar epithelium. Surgery 1957;41:881-894. PMID 13442856.


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Patau's syndrome
From Gale Encyclopedia of Medicine, 4/6/01 by Julia Barrett


Patau's syndrome, also called trisomy 13, occurs when a child is born with three copies of chromosome 13. Normally, two copies of the chromosome are inherited, one from each parent. The extra chromosome causes numerous physical and mental abnormalities. Owing mostly to heart defects, the lifespan of trisomy 13 babies is usually measured in days. Survivors have profound mental retardation.


Individuals normally inherit 23 chromosomes from each parent, for a total of 46 chromosomes. However, genetic errors can occur before or after conception. In the case of Patau's syndrome, an embryo develops which has three copies of chromosome 13, rather than the normal two copies.

Trisomy 13 occurs in approximately 1 in 12,000 live births. In many cases, spontaneous abortion (miscarriage) occurs and the fetus does not survive. The risks of trisomy 13 seem to increase with the mother's age, particularly if she is older than her early 30s. Male and female children are equally affected, and the syndrome occurs in all races.

Causes & symptoms

Patau's syndrome is caused by the presence of three copies of chromosome 13. The presence of these three copies--rather then the normal two--is a random error and cannot be attributed to anything the parents did or did not do.

Newborns with trisomy 13 have numerous internal and external abnormalities. Commonly, the front of the brain fails to divide into lobes or hemispheres, and the entire brain is unusually small. Children who survive infancy have profound mental retardation.

Incomplete development of the optic (sight) and olfactory (smell) nerves often accompanies the brain defects, and the child may also be deaf. Frequently, a child with trisomy 13 has cleft lip, cleft palate, or both. Facial features are flattened and ears are malformed and lowset. Extra fingers or toes (polydactyly) may be present in addition to other hand and foot malformations.

In nearly all cases, trisomy 13 babies have respiratory difficulties and heart defects, including atrial and ventricular septal defects, patent ductus arteriosus, and defects of the pulmonary and aortic valves. Other organ systems may also be affected. The organ defects are frequently severe and life-threatening.


A newborn's numerous malformations indicate a possible chromosomal abnormality. Trisomy 13 is confirmed by examining the infant's chromosomal pattern through karyotyping or another procedure. Trisomy 13 is detectable during pregnancy through the use of ultrasonography, amniocentesis, and chorionic villus sampling.


Patau's syndrome cannot be cured. Some structural abnormalities can be treated through surgery, but malformations are often numerous and severe. Decisions regarding measures to prolong life are best made on an individual basis by the parents and the doctors. Medical treatment may simply focus on making the infant comfortable, rather than prolonging life.

Children who survive infancy require medical treatment to correct structural abnormalities and associated complications. Physical therapy, speech therapy, and other types of developmental therapy will help the child reach his or her potential.


Approximately 82% of trisomy 13 babies die within their first month of life; only 5-10% survive to one year. Survival to adulthood is very rare. Only one adult is known to have survived to age 33.

Survivors have profound mental and physical disabilities; however, trisomy 13 children do have some capacity for learning. Older children may be able to walk with or without a walker. They may also be able to understand words and phrases, follow simple commands, use a few words or signs, and recognize and interact with others.


Patau's syndrome--trisomy 13--is not preventable.

Key Terms

A procedure in which a needle is inserted through a pregnant woman's abdomen and into her uterus to withdraw a small sample of amniotic fluid. The amniotic fluid can be examined for signs of disease or other problems afflicting the fetus.
Chorionic villus sampling
A medical procedure done during weeks 10-12 of a pregnancy. The procedure involves inserting a needle into the placenta and withdrawing a small amount for analysis.
A structure composed of DNA contained within a cell's nucleus. The DNA condenses into these readily recognizable structures only at certain times during cell growth. In humans, DNA is bundled into 23 pairs of chromosomes, each of which has recognizable characteristics--such as length and staining patterns--that allow individual chromosomes to be identified. Identification is assigned by number (1-22) or letter (X or Y).
A laboratory procedure in which chromosomes are separated from cells and stained. The stained chromosomes are examined under a microscope and identified as chromosomes 1-22 and X or Y. There should be two copies each of chromosomes 1-22. The X/Y pair depends on gender. Females have two X chromosomes, and males have both an X and a Y chromosome.
Spontaneous abortion
The uninduced delivery of a fetus before survival outside the mother is possible. Also referred to as a miscarriage.
A condition in which a third copy of a chromosome is inherited. Normally only two copies should be inherited.
A medical test in which sound waves are directed against internal structures in the body. As sound waves bounce off the internal structure, they create an image on a video screen. An ultrasound of a fetus at weeks 16-20 of a pregnancy can be used to determine structural abnormalities.

Further Reading

For Your Information


  • Gardner, R.J. McKinlay, and Grant R. Sutherland. Chromosome Abnormalities and Genetic Counseling. New York: Oxford University Press, 1996.
  • Jones, Kenneth Lyons. Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia: W.B. Saunders Company, 1997.


  • Baty, Bonnie J., Brent L. Blackburn, and John C. Carey. "Natural History of Trisomy 18 and Trisomy 13: I. Growth, Physical Assessment, Medical Histories, Survival, and Recurrence Risk." American Journal of Medical Genetic 49 (1994): 175-187.
  • Baty, Bonnie J., et al. "Natural History of Trisomy 18 and Trisomy 13: II. Psychomotor Development." American Journal of Medical Genetics 49 (1994): 189-194.


  • Support Organization for Trisomy 18, 13, and Related Disorders (SOFT). 2982 South Union Street, Rochester, NY 14624. (800) 716-SOFT.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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