[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Gastrointestinal tract](https://durgical.com/en/general-pathology/areas/gi/) › Barrett oesophagus

# Barrett oesophagus

- Lesion

Long-standing reflux turns the lower oesophageal lining into a gut-like lining; this new lining can become cancerous.

Updated Nov 12, 2026

## Key points

- Endoscopy: tongues of red, velvety mucosa extending up from the junction; long segment is three centimetres or more.
- Goblet cells (pale blue mucin vacuoles shaped like wine goblets) define intestinal metaplasia.
- Found in up to about one in ten people with symptomatic reflux; most common in older white men.
- Dysplasia is graded low or high; high-grade dysplasia carries a real risk of progression to adenocarcinoma.
- Most patients with Barrett never develop cancer, but the risk is many times that of the general population.

## 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.

## Memory aid

A wine glass in the gullet: goblets above the junction mean Barrett.

## 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.

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## Elsewhere in DurgiPedia

- [Esophagus and the Barrett change](https://durgical.com/en/histology/esophagus-and-the-barrett-change/)

## Connections

## Related 5

- [Reflux oesophagitis: what acid does to the squamous lining](https://durgical.com/en/general-pathology/reflux-oesophagitis-what-acid-does-to-the-squamous-lining/)
- [Oesophageal adenocarcinoma: from Barrett to invasive cancer](https://durgical.com/en/general-pathology/oesophageal-adenocarcinoma-from-barrett-to-invasive-cancer/)
- [Metaplasia](https://durgical.com/en/general-pathology/metaplasia/)
- [Dysplasia and carcinoma in situ](https://durgical.com/en/general-pathology/dysplasia-and-carcinoma-in-situ/)
- [Precancerous conditions: when chronic inflammation, metaplasia or hyperplasia raise the risk](https://durgical.com/en/general-pathology/precancerous-conditions-when-chronic-inflammation-metaplasia-or-hyperplasia-rais/)

## Related conditions 5

- [Barrett oesophagus](https://durgical.com/en/conditions/barrett-oesophagus/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Oesophageal cancer](https://durgical.com/en/conditions/oesophageal-cancer/)
- [Obesity](https://durgical.com/en/conditions/obesity/)
- [Hiatal hernia](https://durgical.com/en/conditions/hiatal-hernia/)

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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)](https://www.ncbi.nlm.nih.gov/books/NBK554462/) (StatPearls (NCBI Bookshelf), 2025); [Esophageal Cancer](https://www.ncbi.nlm.nih.gov/books/NBK459267/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/barrett-oesophagus/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/barrett-oesophagus/