Barrett's esophagus

Barrett's esophagus
Diagnosis in short
Esophagus with intestinal metaplasia, as seen in Barrett esophagus. H&E stain.
LM	columnar epithelium with goblet cells
LM DDx	low-grade columnar dysplasia of the esophagus, gastroesophageal reflux disease, nonspecific inflammation at the GE junction
Stains	Alcian blue stain (pH 2.5)
Site	esophagus
Associated Dx	gastroesophageal reflux disease, esophageal adenocarcinoma, columnar dysplasia of the esophagus
Prevalence	relatively common
Endoscopy	red/light brown esophageal mucosa, at gastro-esophageal junction
Prognosis	good
Treatment	on-going surveillance for columnar dysplasia

Intestinal metaplasia of the esophagus redirects here.

Barrett's 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. In the United States and Canada goblet cells are required for the diagnosis. In the UK, goblet cells are not required.
      • One large study suggests that goblets cells are only absent due to undersampling.
• Associated with gastroesophageal reflux disease (GERD).
  • Considered to be a consequence of chronic GERD.

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.

Prague Classification Barrett's Esophagus

• Commonly used in by endoscopists.
• Quantifies the extent of Barrett's esophagus.

Meaning:

• C = circumferential length.
• M = maximal length.

Images

• 

  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.
• Carry over from a concurrent duodenal biopsy - fragments with goblets cells have no gastric-type epithelium.

Images

• 

  BE - low mag.

• 

  BE - intermed. mag.

• 

  BE - high mag.

• 

  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, 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.

Block letters

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 NEGATIVE FOR 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 NEGATIVE FOR 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.