Barrett's esophagus is a complication of chronic gastroesophageal reflux disease (GERD) characterized by intestinal metaplasia within the esophageal squamous mucosa. It is a pre-malignant condition with an increased risk of adenocarcinoma. Risk factors include being male over 50 years old, Caucasian, having a hiatal hernia, being overweight or a current or past smoker. Diagnosis involves endoscopy with biopsy showing goblet cells in the esophageal mucosa. Long segment Barrett's involves over 3 cm of the esophagus while short segment is less than 3 cm.

1. Etiology , morphology
& pathogenesis of
Barret’s esophagus
SHAHANA
GHAZAL
ROLL # 185

2. Barret’s esophagus -an overview
• Barret’s esophagus is a complication of
chronic GERD.
• Characterized by Intestinal metaplasia
within the esophageal squamous mucosa .
• Pre-malignant condition – increased risk
of adenocarcinoma

4. Incidence &
risk factors
- Male (50-60 yrs.)
- Caucasians
- Approx. 10% of patients with chronic symptomatic GERD
- Hiatal hernia
- Overweight , Central obesity
- Current or past smoking

5. Clinical features
Signs and symptoms:
generally due to GERD and may include:
• Frequent heartburn
• Difficulty swallowing food , Odynophagia
• Less commonly, chest pain

6. Etiology
Chronic
GERD
GERD
SMOKING
CENTRAL
OBESITY
SCLERODERMA
HIATAL
HERNIA
CHRONIC
INFLAMMATION

7. Pathophysiology
Normally :
Acid
reflux
Epithelial
injury
Inflammation &
epithelial repair
• Stratified
Squamous
epithelium

8. Contd.
In 10% of the patients with chronic GERD
Chronic GERD
Chronic reflux esophagitis & mucosal
damage
Epithelial layer repair through
columnar metaplasia

9. Possible explanation !
The progenitor (stem cells) in esophagus that would
normally differentiate into squamous epithelial cells are
reprogrammed to develop into columnar epithelial cells.
- metaplastic columnar cells – more resistant to
reflux induced injury
- Esophageal columnar metaplasia predisposes to
adenocarcinoma

10. diagnosis
Upper GI
Endoscopy
Biopsy Microscopic
examination

11. Types of Barret's esophagus based upon
the length of esophagus involved
Either less than or
more than 3 cm
Barret’s esophagus
Long segment Barret's
esophagus
Short segment Barret’s
esophagus
Less than 3
cm
More than 3
cm

12. http://www.dougsamuel.com.au

13. Gross morphology on endoscopic
examination
• Location : Lower part of esophagus (GE Junction)
• Patches of red, velvety mucosa extending upwards from
gastro-esophageal junction
• Metaplastic mucosa alternates with residual smooth ,
pale squamous mucosa proximally
• Interfaces with light brown gastric mucosa distally

14. Image courtesy : American college of gastroenterology patients (AGC patients)

15. Image courtesy : Massachusetts General Hospital

16. Microscopic morphology
• Intestinal / columnar metaplasia with goblet cells
• Goblet cells have distinct mucous vacuoles.
• mentioning the presence / absence of dysplasia and
the grade of dysplasia present ; Low grade / High
grade dysplasia
• Mentioning the presence or absence of neoplastic
cells & their location ; in lamina propria
(intramucosal carcinoma) or beyond that (invasive
carcinoma)

17. Image courtesy : endo-pro magazine

18. Image courtesy : library.med.Utah.edu