Heartburn/GERD Health Center

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Barrett's Esophagus

What is Barrett's esophagus?

Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease ( GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.

There are two requirements for the diagnosis of Barrett's esophagus. To meet these requirements, an endoscopy of the esophagus must be done. In this procedure, a tube is inserted through the mouth and down the esophagus to view and biopsy the lining of the esophagus. The two requirements are:

During endoscopy of the lower esophagus, an abnormal pink lining is seen as replacing the normal whitish lining of the esophagus. This abnormal lining is seen to extend 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).
Biopsy (tissue sampling) of this abnormal lining shows (under the microscope) the presence of intestinal type cells that are called goblet cells, because of their shape. Other cells are also present, some of which resemble stomach cells. However, if intestinal goblet cells are not present, then 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, Drs. Allison and Johnstone actually described this condition along the lines we now understand, namely that a 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 lining of 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 lining of the esophagus was replaced with a mixture of gastric and intestinal lining cells. The intestinal-type lining cells are also called specialized columnar 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.