Elsevier

Human Pathology

Volume 25, Issue 10, October 1994, Pages 982-993
Human Pathology

Barrett's esophagus, dysplasia, and adenocarcinoma

https://doi.org/10.1016/0046-8177(94)90057-4Get rights and content

Abstract

In Barrett's esophagus the normal stratified squamous epithelium lining the esophagus becomes replaced by metaplastic columnar epithelium containing goblet cells; it develops as a complication of chronic gastroesophageal reflux disease and predisposes the patient to adenocarcinoma. The frequency with which it leads to adenocarcinoma is not established with certainty, but the reported prevalence averages approximately 10% when the diagnosis of Barrett's esophagus is first made. The estimated incidence of adenocarcinoma varies from one in 152 to one in 441 cases per patient year, or a 30- to 125-fold excess risk. Esophageal adenocarcinoma arises only in patients with metaplastic columnar epithelium. Dysplasia precedes adenocarcinoma in Barrett's esophagus and arises from the metaplastic epithelium; it has been proposed as a marker for detecting patients at high risk for developing carcinoma. Problems with the use of dysplasia as a marker for cancer risk include difficulty in differentiating it from reactive change, variability in diagnosis and grading between observers and when the same observer interprets the sections on different occasions, and lack of understanding of its natural history. Methods other than dysplasia for detecting patients at highest risk for developing carcinoma have been sought, but flow cytometric analysis of DNA content is the only one proven to be valuable to date. Flow cytometric abnormalities correlate well with histological progression in Barrett's esophagus. The prevalence of elevated S phase and G2/tetraploid fractions and of aneuploid cell populations increases with histological progression from metaplasia to indefinite/low grade dysplasia to high grade dysplasia and cancer. Flow cytometric abnormalities in endoscopic biopsy specimens identify those patients with a higher risk of progression to high grade dysplasia or adenocarcinoma.

References (113)

  • A.J. Cameron

    Molecular events in Barrett's esophagus

    Gastroenterology

    (1993)
  • S.R. Hamilton et al.

    Prevalence and characteristics of Barrett's esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction

    Hum Pathol

    (1988)
  • J.E. McArdle et al.

    Distribution of dysplasias and early invasive carcinoma in Barrett's esophagus

    Hum Pathol

    (1992)
  • B.J. Reid et al.

    Predictors of progression to malignancy in Barrett's esophagus: Endoscopic, histologic and flow cytometric follow-up of a cohort

    Gastroenterology

    (1992)
  • J.J. Thompson et al.

    Barrett's metaplasia and adenocarcinoma of the esophagus and gastroesophageal junction

    Hum Pathol

    (1983)
  • G.M. Woolf et al.

    A study to examine agreement between endoscopy and histology for the diagnosis of columnar lined (Barrett's) esophagus

    Gastrointest Endosc

    (1989)
  • S.A. McClave et al.

    Early diagnosis of columnar-lined esophagus: A new endoscopic diagnostic criterion

    Gastrointest Endosc

    (1987)
  • R.J. Kalish et al.

    Clinical, epidemiologic, and morphologic comparison between adenocarcinomas arising in Barrett's esophageal mucosa and in the gastric cardia

    Gastroenterology

    (1984)
  • H.H. Wang et al.

    Comparative features of esophageal and gastric adenocarcinomas: Recent changes in type and frequency

    Hum Pathol

    (1986)
  • D.S. Levine et al.

    Correlation of ultrastructural aberration with dysplasia and flow cytometric abnormalities in Barrett's epithelium

    Gastroenterology

    (1989)
  • M Jabbari et al.

    The inlet patch: Heterotopic gastric mucosa in the upper esophagus

    Gastroenterology

    (1985)
  • C Van Asche et al.

    Columnar mucosa in the proximal esophagus

    Gastrointest Endosc

    (1988)
  • S.J. Spechler et al.

    Adenocarcinoma and Barrett's esophagus: An overrated risk?

    Gastroenterology

    (1984)
  • DS Levine et al.

    An endoscopic biopsy protocol can differentiate high-grade dysplasia from early adenocarcinoma in Barrett's esophagus

    Gastroenterology

    (1993)
  • BJ Reid et al.

    Endoscopic biopsics diagnose high grade dysplasia or early operable adenocarcinoma in Barrett's esophagus without grossly recognizable neoplastic lesions

    Gastroenterology

    (1988)
  • RH Riddell et al.

    Dysplasia in inflammatory bowel disease: Standardized classification with provisional clinical implications

    Hum Pathol

    (1983)
  • BJ Reid et al.

    Observer variation in the diagnosis of dysplasia in Barrett's esophagus

    Hum Pathol

    (1988)
  • JS Davidson et al.

    Blood group-related antigen expression in normal and metaplastic human upper gastrointestinal mucosa

    Gastroenterology

    (1992)
  • GD Wu et al.

    Sucrase-isomaltase gene expression in Barrett's esophagus and adenocarcinoma

    Gastroenterology

    (1993)
  • JJ Herbst et al.

    Cell proliferation in esophageal columnar epithelium (Barrett's esophagus)

    Gastroenterology

    (1978)
  • MR Gray et al.

    Epithelial proliferation in Barrett's esophagus by proliferating cell nuclear antigen immunolocalization

    Gastroenterology

    (1992)
  • BJ Reid et al.

    Barrett's esophagus: Cell cycle abnormalities in advancing stages of neoplastic progression

    Gastroenterology

    (1993)
  • L Hartwell

    Defects in a cell cycle checkpoint may be responsible for the genomic instability of cancer cells

    Cell

    (1992)
  • BJ Reid et al.

    Flow cytometry complements histology in detecting patients at risk for Barrett's adenocarcinoma

    Gastroenterology

    (1987)
  • BJ Reid

    Barrett's esophagus and esophageal adenocarcinoma

    Gastroenterol Clin North Am

    (1991)
  • MB Fennerty et al.

    Discordance between flow cytometric abnormalities and dysplasia in Barrett's esophagus

    Gastroenterology

    (1989)
  • S Ramel et al.

    Evaluation of p53 protein expression in Barrett's esophagus by two-parameter flow cytometry

    Gastroenterology

    (1992)
  • M Younes et al.

    p53 Protein accumulation in Barrett's metaplasia, dysplasia, and carcinoma: A follow-up study

    Gastroenterology

    (1993)
  • S.J. Spechler et al.

    Barrett's esophagus

    N Engl J Med

    (1986)
  • J Dent et al.
  • M.W. Mulholland et al.

    Elevated gastric acid secretion in patients with Barrett's metaplastic epithelium

    Dig Dis Sci

    (1989)
  • E Hassal

    Barrett's esophagus: New definitions and approaches in children

    J Pediatr Gastroenterol

    (1993)
  • R.C. Haggitt et al.

    Adenocarcinoma in Barrett's epithelium

  • R.C. Haggitt et al.

    Adenocarcinoma complicating columnar epithelial lined (Barrett's) esophagus

    Am J Clin Pathol

    (1978)
  • W.J. Blot et al.

    Rising incidence of adenocarcinoma of the esophagus and gastric cardia

    JAMA

    (1991)
  • C.S. Robertson et al.

    Value of endoscopic surveillance in the detection of neoplastic change in Barrett's esophagus

    Br J Surg

    (1988)
  • R.E. Petras et al.

    Barrett's esophagus. A review of the pathologist's role in diagnosis and management

    Pathol Annu

    (1991)
  • R.W. Phillips et al.

    Barrett's esophagus: Natural historv, incidence, etiology, and complications

    Gastroenterol Clin North Am

    (1991)
  • J Hayward

    The lower end of the esophagus

    Thorax

    (1961)
  • M.R. Gottfried et al.

    Incomplete intestinal metaplasia in the diagnosis of columnar lined esophagus (Barrett's esophagus)

    Am J Clin Pathol

    (1989)
  • Cited by (613)

    • Barrett's Esophagus and Associated Dysplasia

      2024, Gastroenterology Clinics of North America
    • Vision Transformers in medical computer vision—A contemplative retrospection

      2023, Engineering Applications of Artificial Intelligence
    • Early neoplasia identification in Barrett's esophagus via attentive hierarchical aggregation and self-distillation

      2021, Medical Image Analysis
      Citation Excerpt :

      In this regard, early identification and diagnosis of esophageal cancer is essential for improving the survival rate. Barrett’s esophagus (BE) refers to the squamous epithelium of the lower esophagus covered by columnar epithelium, which is considered the main precancerous condition of EAC (Spechler and Goyal, 1986; Haggitt, 1994). However, early neoplasia can be located randomly throughout the esophagus tube with various shape, texture, and size.

    View all citing articles on Scopus

    Supported by National Institutes of Health, Bethesda, MD, grant no. PO1-DK32971.

    View full text