Barrett’s esophagus

by Jason Wasserman MD PhD FRCPC
April 24, 2024

Barrett’s esophagus is a condition where the lining of the esophagus, the tube that carries food from your mouth to your stomach, undergoes a change. Normally, the esophagus is lined by squamous cells, which are well-suited to withstand the mechanical forces of swallowing. In Barrett’s esophagus, this lining changes, and the squamous cells are partly or completely replaced by glandular cells typically seen in the small intestine. This change is called intestinal metaplasia, and it increases the risk of developing esophageal cancer.

What causes Barrett’s esophagus?

The exact cause of Barrett’s esophagus is not fully understood, but it is closely associated with chronic acid reflux, also known as gastroesophageal reflux disease (GERD). GERD causes stomach acid and other contents to flow back into the esophagus, which can irritate and damage the esophageal lining over time, potentially leading to Barrett’s esophagus.

What are the symptoms of Barrett’s esophagus?

Many people with Barrett’s esophagus do not experience any specific symptoms aside from the typical signs of GERD, which include frequent heartburn, difficulty swallowing, and regurgitation of food or sour liquid. However, the presence of these symptoms over a long period may prompt a doctor to check for this condition.

How is the diagnosis of Barrett’s esophagus made?

Barrett’s esophagus is typically diagnosed through upper endoscopy. During this procedure, a doctor uses a thin, flexible tube with a light and camera (endoscope) to look directly at the lining of your esophagus. If the typical orange-pink esophageal lining appears red, the doctor will take a small tissue sample (biopsy) for examination under a microscope to confirm the diagnosis.

What are the microscopic features of Barrett’s esophagus?

Microscopically, Barrett’s esophagus is characterized by the presence of columnar epithelium with goblet cells, which are typically found in the small intestine, not the esophagus. This cellular change is known as intestinal metaplasia and is a key indicator of this condition in biopsy samples.

Barrett's esophagus
Barrett’s esophagus. Intestinal metaplasia including large blue mucin-filled goblet cells can be seen in the center of the image.

What does dysplasia mean, and what is the significance of seeing dysplasia in Barrett’s esophagus?

Dysplasia refers to the presence of abnormal cells that have the potential to turn into cancer over time. In the context of Barrett’s esophagus, dysplasia is graded as either low grade or high grade. Low grade dysplasia shows slight abnormalities in the cells, while high grade dysplasia features more pronounced abnormalities and is more concerning, as it is closer to developing into a type of esophageal cancer called adenocarcinoma. The presence of dysplasia in Barrett’s esophagus requires careful monitoring and sometimes treatment, such as endoscopic therapy or surgery, to prevent progression to cancer.

Barrett's esophagus with low grade dysplasia
This image shows Barrett’s esophagus with low grade dysplasia.

About this article

Doctors wrote this article to help you read and understand your pathology report. Contact us with any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

Other helpful resources

Atlas of Pathology
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