Barrett's esophagus

Intestinal metaplasia of the esophagus redirects here.

Barrett esophagus, abbreviated BE, is a relatively common pathology of the esophagus that is associated with an increased risk of esophageal adenocarcinoma.

General

• Diagnosis is made by clinicans not pathologists.
  • A common histologic correlate is metaplastic transformation of stratified squamous epithelium to simple columnar epithelium with goblet cells.
    • There is disagreement whether goblet cells are required for the diagnosis.
      • One large study suggests that goblets cells are only absent due to undersampling.
• Associated with (chronic) gastroesophageal reflux disease.

Significance of Barrett's esophagus:

• Increased risk of adenocarcinoma of the esophagus.
  • Need on-going surveillance, i.e. long term follow-up/repeat esophagogastroduodenoscopy.

Gross

• Red/light brown esophageal mucosa.
  • Normal mucosa = light pink.

• 

  Endoscopic image of BE. (WC)

Microscopic

Features:

• Columnar epithelium with:
  • Goblet cells - key feature.
  • +/-Moderate chronic inflammation +/- acute inflammation -- common.
  • +/-Mild nuclear hyperchromasia.
• +/-Squamous epithelium with changes of gastroesophageal reflux.

DDx:

• Chronic gastritis.
• Helicobacter gastritis.
• Low-grade columnar dysplasia of the esophagus.

Images

• 

  Barrett's type mucosa. Alcian blue stain. (WC)

• 

  Barrett's type mucosa. Alcian blue stain. (WC/AFIP)

• 

  Barrett's type mucosa. Alcian blue stain. (WC/AFIP)

Stains

• Alcian blue (pH 2.5) - goblet cells +ve.

Sign-out

ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MILD ACUTE INFLAMMATION, SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.

ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH INTESTINAL METAPLASIA AND MODERATE CHRONIC INFLAMMATION, SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND MALIGNANCY.

COMMENT:
The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.

ESOPHAGUS, DISTAL, BIOPSY:
- COLUMNAR EPITHELIUM WITH EXTENSIVE INTESTINAL METAPLASIA, ACUTE AND CHRONIC INFLAMMATION;
- SEE COMMENT.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR DYSPLASIA AND MALIGNANCY.

COMMENT:
The columnar epithelium with intestinal metplasia is seen located deep to the squamous
epithelium.

The findings are consistent with Barrett's esophagus in the appropriate endoscopic setting.

See also

• Esophagus
• GERD.