Barrett’s Esophagus Definition and Complications

Barrett’s esophagus (BE) is defined as columnar metaplasia of esophageal squamous epithelium, of any length, that can be recognized at endoscopy, and is confirmed to have intestinal metaplasia (goblet cells) by mucosal biopsy analysis of the tubular esophagus (1). By definition, this disease does not include intestinal metaplasia of the cardia. Thus, the current definition of BE includes individuals in whom metaplastic epithelium can be identified at endoscopy. Grossly, BE is subdivided into long-segment type (>3cm), short-segment type (13cm), and ultrashort segment type (0-1cm) (2-3). Ultrashort, and short, segment BE can be difficult to distinguish from H. pylori induced chronic carditis with intestinal metaplasia both by clinical and histologic methods (see below) (4). Pathologically, BE consists of fundic type, cardia type (junctional) and specialized intestinal type columnar epithelium (5-7). Depending on the location of the biopsy, the mucosa may show one, two or all three types of mucosa. However, in one study by Weinstein et al., intestinal type columnar epithelium was found in 99% of 250 cases of BE that were greater than 2cm in length (7).