Barrett Esophagus

Overview
  • Barrett Esophagus is a complication of chronic Gastroesophageal Reflux Disease (GERD) whereby the normal stratified squamous epithelium of the esophageal epithelium undergoes metaplasia to columnar epithelium containing goblet cells. Barrett Esophagus occurs in roughly 10% of those with GERD and is more likely in men, especially whites.
Pathogenesis
  • Barrett Esophagus is thought to be caused by repeated bouts of GERD which cause ulceration of the esophageal mucosa. When healing of the ulcers occurs in the presence of refluxed stomach acid, epithelial cells differentiate to a more 'gastric epithelium-like' architecture, characterized by a columnar epithelium containing goblet cells.
Morphology
  • Gross Appearance: Barrett Esophagus under endoscopic examination appears as tongues of darker-pink, velvet-like mucosa extending proximally into the lighter-pink, smooth esophageal mucosa at the gastroesophageal junction.
  • Histological Appearance: The hallmark of Barrett Esophagus is the presence of metaplastic columnar epithelium with goblet cells within the esophageal epithelium.
Clinical Consequences
  • Although Barrett Esophagus is itself asymptomatic, several important complications can arise. It is thought that Barrett metaplasia represents the first pathogenic step in the sequence toward esophageal carcinoma, especially the adenocarcinoma subtype. Repeated injury to the esophageal mucosa may also lead to esophageal strictures and thus development of dysphagia.