Pathology: Barrett's Esophagus
A mock science magazine spread on the pathology of Barrett's esophagus, a condition that occurs when acidic fluids from the stomach frequently flow back into the esophagus. In response, the squamous epithelium of the esophagus is replaced with columnar cells. The challenge of this project was to explain a disease process by visually demonstrating a pathological change in tissue over time.
Client: Prof. Shelley Wall
Content Expert: Dr. John Wong
Media: Procreate, Adobe Illustrator, Adobe Photoshop
Format: 2-page magazine spread
Audience: Educated lay audience
Date: December 2020
First, I needed to understand the disease and make decisions on how it should be visually depicted. I reviewed the literature as well as various illustrations and histology micrographs.
I wrote a short report describing Barrett's esophagus in terms of its etiology, pathogenesis, morphology, and clinical significance.
Images from Hopkin's Medicine (2001)
Image from S.J. Spechler (2013)
Tissue preparatory studies were done in order to visualize the information I had just learnt from my research. The first study was a healthy tissue landscape study that provided an immersive view of the architecture of the esophageal sphincter, both from the viewpoint of within the esophagus and of within the stomach. The second study was a tissue cube study that depicted the development of the pathology over time. A 3D maquette created in Cinema 4D helped provide a starting point for the unique shape of the tissue "cubes." After completing these studies, I decided I wanted to move forward with using the tissue cubes in my final piece rather than using an immersive environment.
In the second study, I chose to combine a schematic and realistic style in order to emphasize the change in the esophagus epithelium. I wanted to show great detail at the microscopic scale of the cellular changes while also showing the overall change of the epithelial shape and colour. While this sacrifices scale accuracy, this would help tell the story to an educated lay audience effectively and in a more engaging manner.
I had a clear idea of how I wanted the layout of the spread to look like from the beginning. I wanted the tissue cubes that I had already created as the focus of the entire piece but I also wanted to make sure that there were other images depicting the pathology at various scales. My intention was that the reader would first be introduced to the pathology at the organ scale where important contextual information is provided and as the viewer moves to the other scales, additional information about the pathology is added each time.
The tissue cubes were also deliberately placed on the page so as to reflect the accurate anatomical position of the distal esophagus as well as to serve as a guide that draws the viewer's eyes from the top-left down to the bottom-right of the entire spread.
I drew colour inspiration from Pinterest colour palette boards and other pathology spreads/posters. Around this time, our class received a short talk by Leila Lax, a past professor of MScBMC, on how to effectively use colour in our illustrations. Her talk inspired me to experiment with combinations of warm and cool colours to draw attention to certain parts of the spread. After receiving feedback from my classmates, I chose to move forward with the light blue and warm pink colours
Rendering was completed in Procreate and Adobe Photoshop. This piece has a lot of cellular details that would have taken forever to render by hand... Instead, I used the bevel and emboss layer styles in Photoshop to add depth to the cells. Text and labelling were completed in Adobe Illustrator.
1. A. (2010, January). Understanding Barrett's Esophagus. Retrieved September 10, 2020, from https://www.asge.org/home/for-patients/patient-information/understanding-barrett-39-s-esophagus 2. Barrett's Esophagus. (2001). Retrieved September 14, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/barretts-esophagus 3. Buja, L. M., & Krueger, G. R. (2013). Netter's Illustrated Human Pathology. (updated edition). Elsevier Health Sciences. 4. Cameron, A. J. (1997). Epidemiology of columnar-lined esophagus and adenocarcinoma. Gastroenterology clinics of North America, 26(3), 487-494. 5. Krstic, R. V. (1991). Human microscopic anatomy: an atlas for students of medicine and biology. Springer Science & Business Media. 6. Liu, L., Gao, H., Wang, H., Zhu, K., Yu, W., Zhang, Y., & Guo, J. (2018). Comparison of esophageal function tests to investigate the effect of Helicobacter pylori Infection on gastroesophageal reflux disease (GERD). Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 24, 4791. 7. Owens, S. R., & Appelman, H. D. (2013). Atlas of esophagus and stomach pathology. Springer Science & Business Media. 8. Santhosh Thaikkadan. (2016, Feb 19). Inside of Stomach - Endoscopy of Normal Stomach [Video]. YouTube. 9. Schlottmann, F., & Patti, M. G. (2018). Esophageal adenocarcinoma: pathogenesis and epidemiology. In Esophageal Cancer (pp. 21-28). Springer, Cham.