Barrett Esophagus
Elizabeth A. Montgomery, MD
Key Facts
Terminology
Columnar-lined esophagus
Change of esophageal mucosa
Any length
Visibility at endoscopy
Contains intestinal metaplasia on biopsy
Outside USA: “Barrett esophagus” is often used for any columnar mucosa found in tubular esophagus
In USA: Term restricted to intestinal metaplasia and requires endoscopic correlation
Etiology/Pathogenesis
Gastroesophageal reflux disease
Male gender
Obesity
White race
Clinical Issues
10-20% of persons with longstanding gastroesophageal reflux
Overall incidence unknown in USA, but prevalence of 1.6% in general Swedish population
“Heartburn”
Key issue: BE is precursor to esophageal adenocarcinoma
Estimated annual risk of adenocarcinoma in patients with BE: 0.5-1%
Strong male predominance
Microscopic Pathology
Columnar metaplasia involving esophagus with goblet cells
 Clinical photograph of endoscopic appearance reveals salmon-colored “tongues” of columnar mucosa above the tops of the gastric folds  . Note the shiny white-tan squamous mucosa  . |
 Hematoxylin & eosin shows easily identifiable goblet cells. There is ample lamina propria. Note cardiac glands below the Barrett mucosa. There is surface nuclear stratification, but the nuclei are not hyperchromatic or enlarged. |
TERMINOLOGY
Abbreviations
Barrett esophagus (BE)
Barrett oesophagus (British spelling) (BO)
Synonyms
Columnar-lined esophagus
Definitions
Change of esophageal mucosa
Any length
Visible at endoscopy
Contains intestinal metaplasia on biopsy
Outside USA: “Barrett esophagus” is often used for any columnar mucosa found in tubular esophagus
In USA: Term restricted to intestinal metaplasia and requires endoscopic correlation
ETIOLOGY/PATHOGENESIS
Risk Factors
Gastroesophageal reflux disease
Hiatal hernia
“Heartburn” symptoms
Male gender
Obesity
White race
Smoking
Alcohol use
CLINICAL ISSUES
Epidemiology
Incidence
10-20% of persons with longstanding gastroesophageal reflux
Overall incidence unknown in USA, but prevalence of 1.6% in general Swedish population
Age
Typically in 5th decade
Gender
Strong male predominance
Ethnicity
Whites most common
Rare in African-Americans
Rare in Southeast Asians
No word for “heartburn” exists in a host of Asian languages
Presentation
Cough
Some patients present with cough from reflux
“Heartburn”
Some patients asymptomatic
Treatment
Surgical approaches
Fundoplication is option to treat reflux; may not be good idea if patient already has Barrett mucosa
Drugs
Anti-reflux medications such as proton pump inhibitors are mainstay of treatment, although antacids and H2 blockers can also be used
Prognosis
Key issue: BE is precursor to esophageal adenocarcinoma
Estimated annual risk of adenocarcinoma in patients with BE: 0.5-1%
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