Barrett oesophagus
- Lesion
Long-standing reflux turns the lower oesophageal lining into a gut-like lining; this new lining can become cancerous.
What it is
Barrett oesophagus is a complication of chronic reflux in which the squamous epithelium of the distal oesophagus is replaced by columnar epithelium of intestinal type. It is thought to be an adaptive change to a hostile acid environment, and it is the main precursor of oesophageal adenocarcinoma. Diagnosis needs both endoscopy (columnar mucosa above the gastro-oesophageal junction) and biopsy.
Structure
- Gross: salmon-red velvety mucosa in tongues or a circumferential band above the junction, with islands of residual pale squamous mucosa.
- Micro: columnar epithelium with goblet cells; gastric foveolar-type cells may be mixed in.
- Low-grade dysplasia: elongated, crowded, hyperchromatic nuclei that fail to mature toward the surface.
- High-grade dysplasia: rounded nuclei, loss of polarity, more atypia and complex glands (budding, gland-within-gland, cribriform).
Step by step
- Chronic reflux repeatedly injures the squamous epithelium.
- Progenitor cells at the junction or in submucosal glands repopulate the surface with columnar cells.
- Intestinal-type differentiation with goblet cells appears (metaplasia).
- Mutations accumulate (TP53, CDKN2A, chromosomal instability): low-grade then high-grade dysplasia.
- Dysplastic cells breach the basement membrane: adenocarcinoma.
Markers
- Goblet cells (Alcian blue at acid pH)
- p53 overexpression or loss in dysplasia
Clinical notes
- Surveillance endoscopy with biopsy is widely used; dysplasia can be ablated or resected endoscopically.
- Multifocal high-grade dysplasia or intramucosal carcinoma may need resection.
Test yourself
Think of the answer, then tap the question to see it.
What cell type confirms intestinal metaplasia in Barrett oesophagus?
Goblet cells, with distinct pale blue mucin vacuoles in columnar epithelium.
What two findings are needed to diagnose Barrett oesophagus?
Columnar mucosa seen at endoscopy above the gastro-oesophageal junction, and biopsy confirmation of metaplastic columnar epithelium.
Which cancer does Barrett oesophagus lead to?
Oesophageal adenocarcinoma, through low-grade and high-grade dysplasia.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Gastroesophageal Reflux Disease (GERD) (StatPearls (NCBI Bookshelf), 2025); Esophageal Cancer (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.