Barrett’s esophagus

Barrett’s esophagus is a condition in which the normal squamous cells lining the lower esophagus are replaced by columnar cells (like those in the intestines) due to chronic acid exposure—usually from gastroesophageal reflux disease (GERD).

This change is called intestinal metaplasia, and it’s significant because it increases the risk of esophageal adenocarcinoma, a type of esophageal cancer.

🧬 Pathophysiology

• Chronic acid reflux → injury to esophageal lining
• Body responds by replacing squamous cells with acid-resistant columnar cells
• These intestinal-type cells are not supposed to be in the esophagus
• Over time, this metaplasia can progress to dysplasia, then cancer in rare cases

⚠️ Risk Factors

😖 Symptoms

Often asymptomatic or symptoms overlap with GERD:

• Chronic heartburn
• Regurgitation
• Difficulty swallowing (dysphagia)
• Chest discomfort
• No specific symptoms due to Barrett’s itself

🧪 Diagnosis

🩺 Upper Endoscopy (EGD):

• Visualizes the salmon-pink mucosa (normal esophagus appears pale)
• Biopsy required to confirm intestinal metaplasia

🧫 Histological Confirmation:

• Presence of goblet cells (seen with special stains) confirms Barrett’s

🧪 Classifying Dysplasia (if present)

💊 Management

✅ If No Dysplasia:

• Long-term proton pump inhibitors (PPIs) to suppress acid
• Repeat endoscopy every 3–5 years

❗ If Dysplasia Detected:

• Endoscopic surveillance more frequently
• Possible intervention:
  • Endoscopic ablation (RFA – radiofrequency ablation)
  • Endoscopic mucosal resection (EMR)
  • Esophagectomy (in select high-risk or cancer cases)

🛡️ Prevention & Lifestyle

• Aggressively treat GERD with PPIs
• Weight loss if overweight
• Avoid alcohol, tobacco, and trigger foods
• Elevate head of bed, avoid late meals
• Eat smaller, more frequent meals

📊 Risk of Progression

🔄 Barrett’s vs GERD