Barrett’s esophagus

by Jason Wasserman MD PhD FRCPC
July 30, 2024

Background:

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.

Dysplasia in Barrett’s esophagus

Dysplasia in Barrett’s esophagus refers to the presence of abnormal cells within the metaplastic epithelium that can eventually turn into esophageal cancer.

Barrett’s esophagus with low grade dysplasia

Low grade dysplasia in Barrett’s esophagus is a condition where cells in the esophagus show mild to moderate abnormalities. These changes indicate a higher risk of developing cancer compared to normal cells but are not as severe as high grade dysplasia. People with low grade dysplasia need to be closely monitored with regular endoscopies to detect any progression. Treatment options might include endoscopic therapies to remove or destroy the abnormal cells, but in many cases, close observation is the primary approach.

Barrett’s esophagus with high grade dysplasia

High grade dysplasia in Barrett’s esophagus is a more serious condition where cells show significant abnormalities and disorganization. This stage is considered a precancerous condition with a high likelihood of progressing to esophageal cancer if left untreated. Because of this high risk, high grade dysplasia often requires prompt and aggressive treatment. This may include endoscopic procedures to remove or destroy the dysplastic tissue and, in some cases, surgery to remove part or all of the esophagus. Regular monitoring and follow-up are crucial to manage and prevent the progression to cancer.

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