Barrett's esophagus (sometimes called Barrett's syndrome, CELLO - columnar
epithelium lined lower (o)esophagus or colloquially as Barrett's) refers to an
abnormal change (metaplasia) in the cells of the lower end of the esophagus
thought to be caused by damage from chronic acid exposure, or reflux
esophagitis. Barrett's esophagus is found in about 10% of patients who seek
medical care for heartburn (gastroesophageal reflux). It is considered to be a
premalignant condition and is associated with an increased risk of esophageal
The condition is named after Dr. Norman Barrett (1903–1979), Australian-born
British surgeon at St Thomas' Hospital, who described the condition in 1957.
Current recommendations include routine endoscopy and biopsy (looking for
dysplastic changes) every 12 months or so while the underlying reflux is
controlled with proton pump inhibitor drugs in combination with measures to
prevent reflux. In severe dysplasia, laser treatment is being used, whereas
overt malignancy may require surgery, radiation therapy, or systemic
chemotherapy. There is presently no reliable way to determine which patients
with Barrett's esophagus will go on to develop esophageal cancer. Endoscopic
mucosal resection has also been evaluated for "Barrett's" management.
Additionally an operation known as a Nissen fundoplication can reduce the reflux
of acid from the stomach into the esophagus.
Barrett's esophagus is marked by the presence of columnar cell epithelium in the
lower esophagus, replacing the normal squamous cell epithelium—an example of
metaplasia. The columnar epithelium is better able to withstand the erosive
action of the gastric secretions; however, this metaplasia confers an increased
cancer risk of the adenocarcinoma type.
The metaplastic columnar cells may be of two types: gastric (similar to those in
the stomach) or colonic (similar to cells in the intestines). A biopsy of the
affected area will often contain a mixture of the two. Colonic-type metaplasia
confers a higher risk of malignancy.
The metaplasia of Barrett's esophagus is visible grossly through a gastroscope,
but biopsy specimens must be examined under a microscope to determine whether
cells are gastric or colonic in nature.
Endoscopic image of Barrett's esophagus, which is the area of red mucosa
projecting like a tongue. Biopsies showed intestinal metaplasia