Citation, DOI, disclosures and article data
At the time the article was created Matt A. Morgan had no recorded disclosures.View Matt A. Morgan's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
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Barrett esophagus is thought to have a prevalence of 3-15% in patients with reflux esophagitis. Mean age at diagnosis is 55 years old 5.
Known risk factors for Barrett esophagus include 10:
~37% of patients (n = 27) who underwent upper endoscopy were found to have Barrett esophagus 5
Barrett esophagus is asymptomatic and usually discovered in a workup for GERD.
Barrett esophagus represents progressive metaplasia of esophageal stratified squamous cell epithelium to columnar epithelium. Although the exact number varies, 90-100% of esophageal adenocarcinoma is thought to arise from this metaplasia.
Although patients with Barrett esophagus have a 30x risk of developing esophageal adenocarcinoma 2, the annual risk of developing adenocarcinoma depends on the degree of histological dysplasia, but may be ~1% (range 0.1-2%), and the absolute risk is low 3.
Because Barrett esophagus represents metaplasia, it is often occult on imaging. Early esophageal adenocarcinoma arising out of Barrett esophagus also may be difficult to see. No radiological imaging modalities are adequate for screening.
double-contrast esophagogram 7
signs of reflux esophagitis
long stricture in the mid or lower esophagus
large deep solitary ulcer
fine reticular mucosal pattern
thickened irregular mucosal folds
earliest signs of developing adenocarcinoma: localized flattening, stiffening, or irregularity in the wall of a stricture
There is a ~70% chance of Barrett esophagus in a midthoracic esophageal stricture ref.
Treatment and prognosis
Since Barrett esophagus is considered a premalignant lesion, confirmation with upper endoscopy and biopsy is warranted.
If Barrett esophagus is confirmed on biopsy, then aggressive therapy for gastro-esophageal reflux is pursued, and perhaps endoscopic surveillance, depending on the patient's age and other risk factors.
One surveillance and biopsy protocol suggests 4:
low-grade dysplasia: 6-12 months
high-grade dysplasia: 3 months
If there is mucosal irregularity (what would be seen on an esophagogram), then endoscopic resection has been recommended 4. Prophylactic resection or ablation has been used by some, particularly in younger patients.
History and etymology
Barrett esophagus is named after Norman Rupert Barrett (1903-1979) 11, an Australian-born thoracic surgeon, who first described the condition in 1950 9.
- 1. Spechler S. Clinical Practice. Barrett's Esophagus. N Engl J Med. 2002;346(11):836-42. doi:10.1056/NEJMcp012118 - Pubmed
- 2. Rastogi A, Puli S, El-Serag H, Bansal A, Wani S, Sharma P. Incidence of Esophageal Adenocarcinoma in Patients with Barrett's Esophagus and High-Grade Dysplasia: A Meta-Analysis. Gastrointest Endosc. 2008;67(3):394-8. doi:10.1016/j.gie.2007.07.019 - Pubmed
- 3. Van der Veen A, Dees J, Blankensteijn J, Van Blankenstein M. Adenocarcinoma in Barrett's Oesophagus: An Overrated Risk. Gut. 1989;30(1):14-8. doi:10.1136/gut.30.1.14 - Pubmed
- 4. Spechler S, Sharma P, Souza R, Inadomi J, Shaheen N. American Gastroenterological Association Medical Position Statement on the Management of Barrett's Esophagus. Gastroenterology. 2011;140(3):1084-91. doi:10.1053/j.gastro.2011.01.030 - Pubmed
- 5. Spechler SJ. Barrett's esophagus. Semin. Gastrointest. Dis. 1996;7 (2): 51-60. Pubmed citation
- 6. Recht MP, Levine MS, Katzka DA et-al. Barrett's esophagus in scleroderma: increased prevalence and radiographic findings. Gastrointest Radiol. 1988;13 (1): 1-5. doi:10.1007/BF01889012 - Pubmed citation
- 7. Gilchrist A, Levine M, Carr R et al. Barrett's Esophagus: Diagnosis by Double-Contrast Esophagography. AJR Am J Roentgenol. 1988;150(1):97-102. doi:10.2214/ajr.150.1.97 - Pubmed
- 8. Levine M. Barrett's Esophagus: A Radiologic Diagnosis? AJR Am J Roentgenol. 1988;151(3):433-8. doi:10.2214/ajr.151.3.433 - Pubmed
- 9. Barrett N. Chronic Peptic Ulcer of the Oesophagus and 'Oesophagitis'. Br J Surg. 1950;38(150):175-82. doi:10.1002/bjs.18003815005 - Pubmed
- 10. Mohy-Ud-Din N, Krill T, Shah A et al. Barrett's Esophagus: What Do We Need to Know? Dis Mon. 2020;66(1):100850. doi:10.1016/j.disamonth.2019.02.003 - Pubmed
- 11. Lord R. Norman Barrett and the Esophagus. Barrett’s Esophagus. 2001;:1-15. doi:10.1007/978-94-017-0829-6_1