BarrettÖsophagus

Barrett’s esophagus (BarrettÖsophagus in some spellings) is a condition in which the normal squamous lining of the distal esophagus is replaced by intestinal-type columnar epithelium with goblet cells. This metaplasia is most often a consequence of chronic gastroesophageal reflux disease (GERD) and is more common in adults with long-standing reflux, older age, white ethnicity, obesity, and smoking. Barrett’s can be described as short-segment (less than 3 cm) or long-segment (3 cm or more). Histologically, the diagnosis is based on specialized intestinal metaplasia with goblet cells confirmed by biopsy.

Diagnosis relies on endoscopic examination with targeted biopsies. Endoscopy findings may include tongues or patches of red, velvety mucosa in the distal esophagus. Biopsy samples are assessed for intestinal metaplasia and dysplasia. The extent of the Barrett’s segment is often described using the Prague C and M criteria, which relate to the circumferential and maximal lengths of the affected area.

Management and surveillance aim to monitor for progression to dysplasia or cancer and to control reflux. All patients are treated for GERD with acid-suppressive therapy, typically proton pump inhibitors, and may receive lifestyle modifications such as weight management and dietary adjustments. Surveillance intervals depend on dysplasia status and segment length: nondysplastic Barrett’s is commonly followed every 3 to 5 years, low-grade dysplasia every 6 to 12 months, and high-grade dysplasia or intramucosal cancer is usually treated with endoscopic eradication therapy (for example, radiofrequency ablation or endoscopic mucosal resection) or, in selected cases, esophagectomy.

Prognosis varies with dysplasia and cancer stage at diagnosis. The overall risk of progression from nondysplastic Barrett’s to cancer is low but higher than in individuals without the condition, underscoring the role of regular surveillance and appropriate therapy.