The Histologic Spectrum of Barrett's Esophagus

TLDR

The study defined the histology of the columnar‑lined esophagus by obtaining manometrically guided biopsies from multiple esophageal levels in 11 patients. Histologic analysis revealed a spectrum of columnar epithelium—atrophic gastric‑fundic, junctional, and specialized villiform intestinal‑type—distributed in a proximal‑distal pattern, with esophagitis unrelated to columnar type, explaining prior discrepant findings.

Abstract

To define the histology of the columnarlined esophagus, we obtained esophageal biopsies from various levels with manometric control from 11 patients. There were three types of columnar epithelia above the lower esophageal sphincter: atrophic gastric-fundic-type epithelium with parietal and chief cells; junctional-type epithelium with cardiac mucous glands; and distinctive specialized columnar epithelium with a villiform surface, mucous glands and intestinal-type goblet cells. When present, specialized columnar epithelium was always the most proximal, and gastric fundic epithelium the most distal epithelium. Junctional epithelium was interposed between gastric fundic and specialized columnar or squamous epithelium. Four patients had unequivocal esophagitis in squamous epithelium, but its presence and severity did not correlate with inflammation in or length or type of distal columnar epithelium. Histoligic study of the columnar-lined esophagus demonstrated a spectrum of epithelial patterns. This heterogeneity helps to explain prior discrepant reports.