Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
are two requirements for the diagnosis of Barrett's esophagus. The requirements necessitate an endoscopy of the esophagus. During endoscopy, a long flexible tube with a light and camera at its tip (an endoscope) is inserted
through the mouth and into the esophagus to view and biopsy (sample tissue from) the lining of the esophagus. The two requirements are:
At endoscopy, an abnormal pink lining should be seen as replacing the normal whitish lining of the esophagus. This abnormal lining extends a short distance (usually less than 2.5 inches) up the esophagus from the gastroesophageal junction (the GE junction, which is where the esophagus joins the stomach).
Microscopic evaluation of the biopsy of this abnormal lining should shows that the normal lining cells of the esophagus have been replaced by intestinal type lining cells, including mucus-producing cells called goblet cells. Other cells also are present, some of which resemble cells that line the stomach. However, if intestinal goblet cells are not present, the diagnosis of Barrett's esophagus should not be made.
Barrett's esophagus is officially coded by the Library
of Congress for electronic searches of the literature as Barrett esophagus, but
Barrett's esophagus (with the apostrophe "s") is the name used universally. The
condition is named after a surgeon, Norman Barrett, who described the condition. However, it turns out that his interpretation of the findings was not correct. In 1953, Doctors' Allison and Johnstone actually described this condition as we now understand it, namely that metaplasia was occurring. (Metaplasia, which is discussed below, is the term used when one adult tissue replaces another.) Nevertheless, the condition has been immortalized with Barrett's name.
Initially, it was thought that the Barrett's esophagus consisted of stomach (gastric) tissue replacing the usual squamous tissue lining the esophagus. However, in the mid 70's, Dr. Paull and colleagues published a paper in which they described the mucosa (inner lining) of Barrett's esophagus in greater detail than had been done previously. They pointed out that Barrett's esophagus consisted of a metaplasia in which the normal cells lining the esophagus were replaced by a mixture of gastric and intestinal lining cells. The intestinal-type lining cells also are called specialized columnar cells which include goblet cells. For a number of years, some scientists thought that there were two types of Barrett's; one in which the normal lining was replaced with stomach (gastric) type cells only, and the second in which intestinal cells were present. However, the current belief is that only the presence of intestinal-type goblet cells establishes the diagnosis of Barrett's esophagus, regardless of what other cell types are present.
Barrett's esophagus has no unique symptoms. Patients with Barrett's have the
symptoms of GERD (for example, heartburn, regurgitation, nausea, etc.). The
general trend is for individuals with Barrett's have more severe GERD. However, not
all Barrett's have marked symptoms of GERD, and some patients are detected
accidentally with minimal or no symptoms of GERD.
Heartburn is a burning sensation behind the breastbone, usually in the lower
half, but may extend all the way up to the throat. Sometimes, it is accompanied
by burning or pain in the pit of the stomach just below where the breastbone
Regurgitation (backup) of bitter tasting
fluid is another common symptom.
The refluxed, regurgitated fluid occasionally may enter the lungs or the
voice box, resulting in what are called extraesophageal symptoms of GERD. These symptoms include:
Many years ago, Schatzki described a
smooth, benign, circumferential, and narrow ring of tissue in the lower end of
the esophagus (the food pipe that connects the mouth to the stomach). These rings