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  • Replacement of normal squamous epithelium of the distal esophagus with specialized intestinal metaplasia.
  • Endoscopy and biopsy are essential for an accurate diagnosis.
  • Presence of high-grade dysplasia should be confirmed by two expert gastrointestinal pathologists.
  • Risk factors for progression to adenocarcinoma include a large hiatal hernia, long segment of Barrett esophagus, and mucosal abnormalities (nodules, ulcerations, or strictures).

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Barrett esophagus is named after a London thoracic surgeon who published a paper in 1950 entitled "Chronic Peptic Ulcer of the Esophagus and 'Oesophagitis.'" In this article, Norman Barrett described cases of esophageal ulcers surrounded by columnar mucosa found at autopsy. Barrett esophagus is the replacement of the normal squamous epithelium of the distal esophagus with specialized intestinal metaplasia (SIM). It is thought to be caused by chronic gastroesophageal reflux disease (GERD), which leads to esophagitis and subsequent metaplastic change of the esophageal lining. SIM may be protective against further injury by gastric acid; however, this metaplastic epithelium is also associated with an increased risk for esophageal adenocarcinoma. There is considerable ongoing debate regarding various aspects of Barrett esophagus, such as the exact neoplastic risk it confers as well as its management if it has become dysplastic.

Barrett NR. Chronic peptic ulcer of the oesophagus and "oesophagitis." Br J Surg. 1950;38:175–182.   [PubMed: 14791960]
Sharma P. Clinical practice. Barrett's esophagus. N Engl J Med. 2009;361:2548–2556.   [PubMed: 20032324]

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Epidemiology

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The overall prevalence of Barrett esophagus in the general adult population is thought to be 1.6–1.7% (although estimates have varied widely from 0.9% to more than 20% depending on the population studied and the definition of Barrett esophagus). As of the 2010 Census, this would translate to nearly 4.0 million individuals with the condition in the United States. In patients with GERD, the prevalence of Barrett esophagus is higher, approximately 5–10%. In patients with severe GERD, such as those with erosive esophagitis, the prevalence is approximately 10%; in patients with peptic strictures of the esophagus, the prevalence is almost 30%. Barrett esophagus affects males more than females by a ratio of approximately 3:1. The typical patient is a Caucasian, middle-aged male. Although the prevalence of Barrett esophagus in Hispanics appears to be similar to that in Caucasians, Barrett esophagus is uncommon in blacks and Asians. In certain studies, alcohol and smoking have been found to be risk factors for the presence of Barrett esophagus. The conclusion that Barrett esophagus is an acquired complication of chronic GERD is supported by the fact that Barrett esophagus is exceedingly rare in children with competent lower esophageal sphincters (LES).

El-Serag HB, Gilger MA, Shub MD, et al. The prevalence of suspected Barrett's esophagus in children and adolescents: a multicenter endoscopic study. Gastrointest Endosc. 2006;64: 671–675.   [PubMed: 17055854]
Evans DE, Barron WG. 2000 Census of Population and Housing. U.S. Department of Commerce Economics and Statistics, 2005.
Ronkainen J, ...

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