Barretts esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine. This change is considered to be a premalignant condition because it is associated with a high incidence of further transition to esophageal adenocarcinoma, an often-deadly cancer.The main cause of Barretts esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis. Barretts esophagus is diagnosed by endoscopy: observing the characteristic appearance of this condition by direct inspection of the lower esophagus; followed by microscopic examination of tissue from the affected area obtained from biopsy. The cells of Barretts esophagus are classified into four categories: nondysplastic, low-grade dysplasia, high-grade dysplasia, and frank carcinoma. High-grade dysplasia and early stages of adenocarcinoma may be treated by endoscopic resection or radiofrequency ablation. Later stages of adenocarcinoma may be treated with surgical resection or palliation. Those with nondysplastic or low-grade dysplasia are managed by annual observation with endoscopy, or treatment with radiofrequency ablation. In high-grade dysplasia, the risk of developing cancer might be at 10% per patient-year or greater.The incidence of esophageal adenocarcinoma has increased substantially in the Western world in recent years. The condition is found in 5–15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, or GERD), although a large subgroup of patients with Barretts esophagus are asymptomatic.
Pruritus vulvae is itchiness of the vulva, which is the counterpart of pruritus scroti, and may have many different causes. : 56   Patch testing may be used to diagnose the cause. Causes
This condition is a symptom of an underlying condition more often than it is a primary condition. Vulva irritation can be caused by any moisture left on the skin. This moisture may be perspiration, urine, vaginal discharge or small amounts of stool. It may be caused by vaginal infections, vulvitis, HPV (human papilloma virus) infection, anal incontinence, Bowens disease, or dietary irritants (caffeine, potatoes, chilli, capsicum, tomatoes, and peanuts). Treatment with antibiotics can lead to a yeast infection and irritation of the vulva. Some diseases increase the possibility of yeast infections, such as diabetes mellitus. Chronic inflammation of the vulva predisposes to the development of premalignant or malignant changes. == References ==