Barrett's esophagus

Barrett's esophagus is metaplasia of the lower end of the esophagus caused by chronic reflux esophagitis and is present in about 10% of patients who present with reflux. It is a premalignant condition and is associated with an increased risk of esophageal cancer.

Treatment

Current recommendations are for endoscopy and biopsy (looking for dysplastic changes) every 12 months or so whilst the underlying reflux should be controlled with H2 antagonists or proton pump inhibitor drugs. In severe dysplasia, laser treatment is being used, while overt malignancy requires surgery.

Pathology

It is marked by the presence of columnar cell epithelium in the lower esophagus which replaces the squamous cell epithelium. This is an example of metaplasia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions. There is an increased cancer risk of the adenocarcinoma type.

The metaplastic columnar cells may be of two types. They may be gastric (similar to those in the stomach) or colonic (similar to cells in the intestines). A biopsy will usually contain a mixture of the two. Colonic-type metaplasia is at higher risk of malignancy. The metaplasia of Barrett's esophagus is visible grossly through a gastroscope, but needs to be examined under a microscope to determine whether cells are gastric or colonic.