Barrett Oesophagus

• As a result of prolonged injury, the distal squamous epithelium is replaced with metaplastic columnar epithelium
• It is the most important risk factor for oesophageal adenocarcinoma
• It occurs in 10% of patients with GORD
• Two criteria are required for a diagnosis of Barrett oesophagus;
  • Endoscopic evidence of columnar epithelial lining above the gastro-oesophageal junction
  • Histological evidence of intestinal metaplasia in the biopsy specimens from the columnar epithelium

 

• The pathogenesis is unclear however re-epithelialisation by pluripotent stem cells in a low pH environment induced differentiation into gastric and intestinal type epithelium

 

Morphology

• Gross – irregular circumferential band of red velvety mucosa at the gastro-oesophageal junction, with linear streaks or patches of similar mucosa in the distal oesophagus
• Microsopic – intestinal type columnar epithelium (both with absorptive epithelial cells and mucin secreting oblet cells) interspersed with glandular gastric columnar mucosa
• Epithelial cell dysplasia can arise in Barrett oesophagus

 

Clinical

• Incidence is highest in white males, particularly between the ages of 40 to 60
• Complications include ulceration with bleeding and stricture formation
• Adenocarcinoma risk is increased 30 to 40 fold