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Barrett Esophagus : Diagnosis

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The diagnosis of Barrett esophagus (BE) requires both endoscopic and histologic findings.

Endoscopically, the distal esophagus must be lined by columnar epithelium, which has an orange-pink (salmon-colored) appearance and velvety texture. It is easily distinguished from normal esophageal squamous epithelium which is pale pink and glossy. To qualify for BE, this mucosal change must extend at least 1 cm above the gastroesophageal junction.

The guidelines provided by the American College of Gastroenterology require endoscopically abnormal areas to show unequivocal intestinal-type epithelium with goblet cells (intestinal metaplasia). In some countries, such as the United Kingdom and Japan, the presence of gastric cardiac-type epithelium which consists solely of mucus-secreting cells is considered sufficient for the diagnosis of BE.

About this image: This endoscopic image shows long-segment BE (metaplastic epithelium extends at least 3 cm above the esophagogastric junction). In short-segment BE, less than 3 cm of metaplastic epithelium lines the distal esophagus. The normal esophageal squamous epithelium is present at the periphery and as a tongue-shaped area just to the right of the lumen. It is pale pink and smooth.

Image courtesy of: Pramod Malik, MD; used with permission.

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