esôfago de Barrett

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Aug 2025

Last updated: 15 Oct 2024

Esôfago de Barrett é uma alteração no epitélio escamoso normal do esôfago para metaplasia intestinal especializada.

A apresentação pode ser assintomática, mas ocorre tipicamente em homens brancos de meia-idade que tiveram doença do refluxo gastroesofágico (DRGE) crônica. Os fatores de risco adicionais incluem o tabagismo e a obesidade.

O risco de câncer é determinado pelo grau de displasia.

Os programas de vigilância e uso da endoscopia como meio de rastreamento apresentam várias desvantagens. O rastreamento da população em geral não é recomendado, e os intervalos de vigilância variam de acordo com os achados histológicos.

Os inibidores da bomba de prótons normalmente são usados para controlar os sintomas da DRGE e podem reduzir o risco de esôfago de Barrett neoplásico.

As terapias endoscópicas desempenham um papel central no tratamento do esôfago de Barrett displásico e do adenocarcinoma esofágico precoce.

Definition

Esôfago de Barrett é uma alteração no epitélio escamoso normal do esôfago para metaplasia intestinal especializada.[1] Isso está associado ao refluxo gastroesofágico, mesmo que o refluxo seja assintomático.[2][3] A histologia mostrando epitélio com revestimento colunar é essencial para o diagnóstico, com ou sem metaplasia intestinal e com células caliciformes.[4] Além dos sintomas relacionados ao refluxo gastroesofágico, a principal preocupação é o aumento do risco de adenocarcinoma do esôfago.[2][3][Figure caption and citation for the preceding image starts]: Esôfago de Barrett; mucosa cor de salmão estendendo-se acima da junção gastroesofágica como uma coluna contínuaDa coleção pessoal do Dr. Vic Velanovich; usado com permissão [Citation ends]. com.bmj.content.model.Caption@5fcea717 [Figure caption and citation for the preceding image starts]: Esôfago de Barrett; mucosa cor de salmão estendendo-se acima da junção gastroesofágica com uma borda acentuada irregularDa coleção pessoal do Dr. Vic Velanovich; usado com permissão [Citation ends]. com.bmj.content.model.Caption@410a3b06 [Figure caption and citation for the preceding image starts]: Metaplasia de Barrett sem displasia, mostrando o epitélio colunar com células caliciformes da região superior à junção gastroesofágicaCortesia de Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. com.bmj.content.model.Caption@48dee419 [Figure caption and citation for the preceding image starts]: Metaplasia de Barrett com displasia de baixo grau; células e núcleos mais irregularesCortesia de Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].[Figure caption and citation for the preceding image starts]: Metaplasia de Barrett com displasia de alto grau; irregularidade mais avançada das célulasCortesia de Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. com.bmj.content.model.Caption@55ce122c [Figure caption and citation for the preceding image starts]: Metaplasia de Barrett com displasia de alto grau associada a um foco de carcinoma intramucoso; células francamente malignas além da extensão da membrana basal envolvendo a lâmina própriaCortesia de Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. com.bmj.content.model.Caption@51166338

History and exam

Key diagnostic factors

presença de fatores de risco
pirose
regurgitação
disfagia

Full details

Other diagnostic factors

achado incidental durante uma endoscopia digestiva por outra indicação
dor torácica
laringite
tosse
dispneia ou sibilância
história de pneumonia por aspiração

Full details

Risk factors

refluxo de ácido-bile ou DRGE
envelhecimento
etnia branca
sexo masculino
história familiar de esôfago de Barrett ou adenocarcinoma esofágico
obesidade
tabagismo

Full details

Diagnostic tests

1st tests to order

endoscopia digestiva alta com biópsia
esofagograma com bário

Full details

Emerging tests

cromoendoscopia
imagem por autofluorescência
endomicroscopia confocal a laser
tomografia de coerência óptica
espectroscopia
endoscopia transnasal
endoscopia por cápsula
esponja revestida com gelatina

Treatment algorithm

ACUTE

esôfago de Barrett não displásico

displasia de baixo grau

displasia de alto grau

Contributors

Authors

Andres F. Carrion, MD

Associate Professor of Medicine

Division of Gastroenterology and Hepatology

University of Miami

Miller School of Medicine

Miami

Disclosures

AFC is a scientific advisor for Intercept Pharmaceuticals and Gilead Sciences, and is on the speaker bureau for Bristol-Myers Squibb, Intercept Pharmaceuticals, Merck, and Alexion.

Ricardo Badillo, MD

Assistant Professor of Medicine

Division of Gastroenterology

Texas Tech University Health Sciences Center

El Paso

Disclosures

RB declares that he has no competing interests.

Marc J. Zuckerman, MD

Professor of Medicine

Chief

Division of Gastroenterology

Texas Tech University Health Sciences Center

El Paso

Disclosures

MJZ is on the speakers bureau for Phathom Pharmaceuticals.

Acknowledgements

Dr Andres F. Carrion, Dr Ricardo Badillo and Dr Marc J. Zuckerman would like to gratefully acknowledge Dr Vic Velanovich, the previous contributor to this topic.

Disclosures

VV is an author of a number of references cited in this topic.

Peer reviewers

Richard E. Sampliner, MD

Professor

Medicine Chief

Department of Gastroenterology

University of Arizona College of Medicine

Tucson

Disclosures

RES declares that he has no competing interests.

Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)

Clinical Reader in Surgery

Nuffield Department of Surgery

University of Oxford

Oxford

Disclosures

PM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text Abstract

Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-87.Full text Abstract

Fitzgerald RC. Molecular basis of Barrett's oesophagus and oesophageal adenocarcinoma. Gut. 2006 Dec;55(12):1810-20. Abstract

Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017 Feb;49(2):191-8.Full text Abstract

Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology. 2006 Nov;131(5):1392-9.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Esofagite
- Doença do refluxo gastroesofágico (DRGE)
- Adenocarcinoma esofágico
More Differentials
Guidelines
- Endoscopic eradication therapy of Barrett’s esophagus and related neoplasia
- Adverse events associated with EGD and EGD-related techniques
More Guidelines
Patient information
Refluxo gastroesofágico, pirose e doença do refluxo gastroesofágico (DRGE)
Faringite
More Patient information
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esôfago de Barrett

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Emerging tests

Treatment algorithm

esôfago de Barrett não displásico

displasia de baixo grau

displasia de alto grau

Contributors

Authors

Andres F. Carrion, MD

Disclosures

Ricardo Badillo, MD

Disclosures

Marc J. Zuckerman, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Richard E. Sampliner, MD

Disclosures

Peter McCulloch, MBChB, MA, MD, FRCS (Ed), FRCS (Glas)

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice