Barrett Esophagus

Definition

Intestinal type mucosa with goblet cells present above the gastroesophageal junction

The diagnosis of Barrett esophagus is clinicopathological and requires both of the following:
- Endoscopic identification of columnar mucosa extending proximally into the tubular esophagus
- Histopathologic identification of columnar epithelium with goblet cells
  - Distended, sharply defined, mucin-filled cytoplasm
    - Alcian blue positive at pH 2.5
  - Fundic or cardiac type mucosa may be present but are not specific
The presence of dysplasia in Barrett esophagus appears to be related to the development or presence of adenocarcinoma
Note:
- The gastroesophageal junction is the anatomic junction of the saccular stomach with the tubular esophagus
- The squamo-columnar junction is where the glandular mucosa meets the squamous mucosa
- The lower esophageal sphincter is the distal 1 cm of the tubular esophagus, a region of increased pressure
A hiatal hernia is the presence of a portion of the saccular stomach above the diaphragmatic notch
Barrett esophagus may be defined by its length
- Long segment at least 3 cm
- Short segment <3 cm
- Ultra-short segment <1 cm
  - Extremely difficult to distinguish from an irregular EG junction
Pancreatic metaplasia is seen frequently in biopsies from the EGJ
- It is not clear if this represents metaplasia or heterotopia
- No clinical significance

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates : 11/11/09, 2/3/10, 10/25/10