Barrett esophagus

Barrett esophagus is a change in the normal squamous epithelium of the esophagus to specialized intestinal metaplasia.

Presentation may be asymptomatic, but it typically occurs in middle-aged white men who have had chronic gastroesophageal reflux disease (GERD). Additional risk factors include tobacco use and obesity.

Cancer risk is determined by the degree of dysplasia.

Endoscopic screening and surveillance programs have multiple shortcomings. Screening of the general population is not recommended, and surveillance intervals vary depending on histologic findings.

Proton-pump inhibitors (PPIs) are commonly used to control GERD symptoms and may reduce the risk of neoplastic Barrett esophagus.

Endoscopic therapies play a central role in the management of dysplastic Barrett esophagus and early esophageal adenocarcinoma.

Barrett esophagus is a change in the normal squamous epithelium of the esophagus to specialized intestinal metaplasia.[1]Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014 Jan;63(1):7-42. http://gut.bmj.com/content/63/1/7.long http://www.ncbi.nlm.nih.gov/pubmed/24165758?tool=bestpractice.com This is associated with gastroesophageal reflux, even if the reflux is asymptomatic.[2]Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006 Jul;22(4):406-11. http://www.ncbi.nlm.nih.gov/pubmed/16760758?tool=bestpractice.com [3]Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005 May;128(6):1554-66. http://www.ncbi.nlm.nih.gov/pubmed/15887151?tool=bestpractice.com Essential to the diagnosis is histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells.[4]Flejou JF, Svrcek M. Barrett's oesophagus: a pathologist's view. Histopathology. 2007 Jan;50(1):3-14. http://www.ncbi.nlm.nih.gov/pubmed/17204017?tool=bestpractice.com  Beyond gastroesophageal reflux-related symptoms, the main concern is the increased risk of adenocarcinoma of the esophagus.[2]Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006 Jul;22(4):406-11. http://www.ncbi.nlm.nih.gov/pubmed/16760758?tool=bestpractice.com [3]Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005 May;128(6):1554-66. http://www.ncbi.nlm.nih.gov/pubmed/15887151?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Barrett esophagus; note salmon-colored mucosa extending superior to the gastroesophageal junction as a continuous columnFrom the personal collection of Dr Vic Velanovich; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Barrett esophagus; note salmon-colored mucosa extending superior to the gastroesophageal junction with marked irregular borderFrom the personal collection of Dr Vic Velanovich; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Barrett metaplasia without dysplasia, demonstrating columnar epithelium with goblet cells from superior to the gastroesophageal junctionCourtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].[Figure caption and citation for the preceding image starts]: Barrett metaplasia with low-grade dysplasia; note the more irregular cells and nucleiCourtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].[Figure caption and citation for the preceding image starts]: Barrett metaplasia with high-grade dysplasia; note more advanced irregularity of the cellsCourtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].[Figure caption and citation for the preceding image starts]: Barrett metaplasia with high-grade dysplasia associated with a focus of intramucosal carcinoma; note the frankly malignant cells beyond the confines of the basement membrane to involve the lamina propriaCourtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].