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Histology: The Different Points of View on Barret’s Esophagus

  • Vincenzo Villanacci
  • Karel Geboes
  • Tiziana Salviato
  • Gabrio Bassotti
Chapter

Abstract

In 1950, Dr. Norman Barrett published a paper in the British Journal of Surgery with the title “Chronic peptic ulcer of the oesophagus and oesophagitis.” This was later followed by another paper, entitled “The lower esophagus, lined by columnar epithelium.” The history of what is now called “Barrett’s esophagus” is characterized by different definitions over time and in different geographic areas, and by different ideas between different medical professions. In the present review, the current view of this condition is presented, based upon endoscopy and pathology and consensus between different medical specialties. The pathogenesis is discussed and guidelines for the diagnosis are proposed. The diagnosis, based upon endoscopy and histology, is important because of the association between Barrett’s esophagus and cancer. Early detection is therefore essential and the criteria for the diagnosis of dysplasia are reviewed including recommendations for the endoscopic procedures.

Keywords

Barrett’s esophagus Endoscopy Intestinal metaplasia Dysplasia Cancer development 

References

  1. 1.
    Spechler SJ, Goyal RK. Barrett’s esophagus. N Engl J Med. 1986;315:362–71.CrossRefGoogle Scholar
  2. 2.
    Jankowski J, Barr H, Wang K, Delaney B. Diagnosis and management of Barrett’s oesophagus. BMJ. 2010;341:c4551.CrossRefGoogle Scholar
  3. 3.
    Collen MJ, Lewis JH, Benjamin SB. Gastric acid hypersecretion in refractory gastroesophageal reflux disease. Gastroenterology. 1990;98:654–61.CrossRefGoogle Scholar
  4. 4.
    Mulholland MW, Reid BJ, Levine DS, Rubin CE. Elevated gastric acid secretion in patients with Barrett’s metaplastic epithelium. Dig Dis Sci. 1989;34:1329–34.CrossRefGoogle Scholar
  5. 5.
    Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373:850–61.CrossRefGoogle Scholar
  6. 6.
    Dixon MF, Mapstone NP, Neville PM, Moayyedi P, Axon AT. Bile reflux gastritis and intestinal metaplasia at the cardia. Gut. 2002;51:351–5.CrossRefGoogle Scholar
  7. 7.
    Hackelsberger A, Gunther T, Schultze V, Manes G, Dominguez-Munoz JE, Roessner A, Malfertheiner P. Intestinal metaplasia at the gastro-oesophageal junction: helicobacter pylori gastritis or gastro-oesophageal reflux disease? Gut. 1998;43:17–21.CrossRefGoogle Scholar
  8. 8.
    Haggitt RC, Tryzelaar J, Ellis FH, Colcher H. Adenocarcinoma complicating columnar epithelium-lined (Barrett’s) esophagus. Am J Clin Pathol. 1978;70:1–5.CrossRefGoogle Scholar
  9. 9.
    Villanacci V, Rossi E, Zambelli C, Galletti A, Cestari R, Missale G, Casa DD, Bassotti G. COX-2, CDX2, and CDC2 immunohistochemical assessment for dysplasia-carcinoma progression in Barrett’s esophagus. Dig Liver Dis. 2007;39:305–11.CrossRefGoogle Scholar
  10. 10.
    Blot WJ. Esophageal cancer trends and risk factors. Semin Oncol. 1994;21:403–10.PubMedGoogle Scholar
  11. 11.
    Haggitt RC. Adenocarcinoma in Barrett’s esophagus: a new epidemic? Hum Pathol. 1992;23:475–6.CrossRefGoogle Scholar
  12. 12.
    Bombeck CT, Dillard DH, Nyhus LM. Muscular anatomy of the gastroesophageal junction and role of phrenoesophageal ligament; autopsy study of sphincter mechanism. Ann Surg. 1966;164:643–54.CrossRefGoogle Scholar
  13. 13.
    Chandrasoma PT, Lokuhetty DM, Demeester TR, Bremmer CG, Peters JH, Oberg S, Groshen S. Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol. 2000;24:344–51.CrossRefGoogle Scholar
  14. 14.
    Der R, Tsao-Wei DD, Demeester T, Peters J, Groshen S, Lord RV, Chandrasoma P. Carditis: a manifestation of gastroesophageal reflux disease. Am J Surg Pathol. 2001;25:245–52.CrossRefGoogle Scholar
  15. 15.
    Oberg S, Peters JH, DeMeester TR, Chandrasoma P, Hagen JA, Ireland AP, Ritter MP, Mason RJ, Crookes P, Bremner CG. Inflammation and specialized intestinal metaplasia of cardiac mucosa is a manifestation of gastroesophageal reflux disease. Ann Surg. 1997;226:522–30; discussion 30–2.CrossRefGoogle Scholar
  16. 16.
    Adler DG, Farraye FA, Crawford JM. Gastrointestinal tract endoscopic and tissue processing techniques and normal histology. In: Odze RD, Goldblum JR, editors. Odze and Goldblum surgical pathology of the GI tract, liver, biliary tract, and pancreas. 3rd ed. Philadelphia: Elsevier Saunders; 2015. p. 4–33.Google Scholar
  17. 17.
    Rege TA, Noffsinger AE. The nonneoplastic esophagus. In: Noffsinger A, editor. Fenoglio-Presiser’s gastrointestinal pathology. 4th ed. Philadelphia: Wolters Kluwer; 2008. p. 11–95.Google Scholar
  18. 18.
    Owen DA. Stomach. In: Sternberg SS, editor. Histology for pathologists. New York: Raven Press; 1992. p. 533–45.Google Scholar
  19. 19.
    Chandrasoma PT, Der R, Ma Y, Dalton P, Taira M. Histology of the gastroesophageal junction: an autopsy study. Am J Surg Pathol. 2000;24:402–9.CrossRefGoogle Scholar
  20. 20.
    Kilgore SP, Ormsby AH, Gramlich TL, Rice TW, Richter JE, Falk GW, Goldblum JR. The gastric cardia: fact or fiction? Am J Gastroenterol. 2000;95:921–4.CrossRefGoogle Scholar
  21. 21.
    De Hertogh G, Van Eyken P, Ectors N, Geboes K. On the origin of cardiac mucosa: a histological and immunohistochemical study of cytokeratin expression patterns in the developing esophagogastric junction region and stomach. World J Gastroenterol. 2005;11:4490–6.CrossRefGoogle Scholar
  22. 22.
    Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology. 1996;110:614–21.CrossRefGoogle Scholar
  23. 23.
    Chandrasoma P, Wijetunge S, Ma Y, Demeester S, Hagen J, Demeester T. The dilated distal esophagus: a new entity that is the pathologic basis of early gastroesophageal reflux disease. Am J Surg Pathol. 2011;35:1873–81.CrossRefGoogle Scholar
  24. 24.
    Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett’s esophagus. N Engl J Med. 1976;295:476–80.CrossRefGoogle Scholar
  25. 25.
    Haggitt RC. Barrett’s esophagus, dysplasia, and adenocarcinoma. Hum Pathol. 1994;25:982–93.CrossRefGoogle Scholar
  26. 26.
    Weinstein WM, Ippoliti AF. The diagnosis of Barrett’s esophagus: goblets, goblets, goblets. Gastrointest Endosc. 1996;44:91–5.CrossRefGoogle Scholar
  27. 27.
    Costamagna G, Battaglia G, Repici A, Fiocca R, Rugge M, Spada C, Villanacci V. Diagnosis and endoscopic management of Barrett’s esophagus: an Italian Experts’ opinion based document. Dig Liver Dis. 2017;49:1306.CrossRefGoogle Scholar
  28. 28.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 43.CrossRefGoogle Scholar
  29. 29.
    Chandrasoma P, Wijetunge S, Demeester SR, Hagen J, Demeester TR. The histologic squamo-oxyntic gap: an accurate and reproducible diagnostic marker of gastroesophageal reflux disease. Am J Surg Pathol. 2010;34:1574–81.PubMedGoogle Scholar
  30. 30.
    Lenglinger J, See SF, Beller L, Cosentini EP, Asari R, Wrba F, Riegler M, Schoppmann SF. Review on novel concepts of columnar lined esophagus. Wien Klin Wochenschr. 2013;125:577–90.CrossRefGoogle Scholar
  31. 31.
    Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1998;93:1028–32.CrossRefGoogle Scholar
  32. 32.
    Sharma P. Short segment Barrett esophagus and specialized columnar mucosa at the gastroesophageal junction. Mayo Clin Proc. 2001;76:331–4.CrossRefGoogle Scholar
  33. 33.
    Weston AP, Krmpotich P, Makdisi WF, Cherian R, Dixon A, McGregor DH, Banerjee SK. Short segment Barrett’s esophagus: clinical and histological features, associated endoscopic findings, and association with gastric intestinal metaplasia. Am J Gastroenterol. 1996;91:981–6.PubMedGoogle Scholar
  34. 34.
    Batts KP. Barrett esophagus—more steps forward. Hum Pathol. 2001;32:357–9.CrossRefGoogle Scholar
  35. 35.
    Offner FA, Lewin KJ, Weinstein WM. Metaplastic columnar cells in Barrett’s esophagus: a common and neglected cell type. Hum Pathol. 1996;27:885–9.CrossRefGoogle Scholar
  36. 36.
    Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–6.CrossRefGoogle Scholar
  37. 37.
    Johnston MH, Hammond AS, Laskin W, Jones DM. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol. 1996;91:1507–11.PubMedGoogle Scholar
  38. 38.
    Nandurkar S, Talley NJ, Martin CJ, Ng TH, Adams S. Short segment Barrett’s oesophagus: prevalence, diagnosis and associations. Gut. 1997;40:710–5.CrossRefGoogle Scholar
  39. 39.
    Trudgill NJ, Suvarna SK, Kapur KC, Riley SA. Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy. Gut. 1997;41:585–9.CrossRefGoogle Scholar
  40. 40.
    Ormsby AH, Goldblum J, Richter JE, Falk GW, Gramlich TL. The sensitivity and specificity of histologic features in the diagnosis of Barrett’s esophagus on routine endoscopic biopsy specimens. Am J Clin Pathol. 1999;112:A533.Google Scholar
  41. 41.
    Hirota WK, Loughney TM, Lazas DJ, Maydonovitch CL, Rholl V, Wong RK. Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. Gastroenterology. 1999;116:277–85.CrossRefGoogle Scholar
  42. 42.
    Morales TG, Sampliner RE, Bhattacharyya A. Intestinal metaplasia of the gastric cardia. Am J Gastroenterol. 1997;92:414–8.PubMedGoogle Scholar
  43. 43.
    Goldblum JR, Vicari JJ, Falk GW, Rice TW, Peek RM, Easley K, Richter JE. Inflammation and intestinal metaplasia of the gastric cardia: the role of gastroesophageal reflux and H. pylori infection. Gastroenterology. 1998;114:633–9.CrossRefGoogle Scholar
  44. 44.
    Riddell RH, Goldman H, Ransohoff DF, Appelman HD, Fenoglio CM, Haggitt RC, Ahren C, Correa P, Hamilton SR, Morson BC, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications. Hum Pathol. 1983;14:931–68.CrossRefGoogle Scholar
  45. 45.
    Goseki N, Koike M, Yoshida M. Histopathologic characteristics of early stage esophageal carcinoma. A comparative study with gastric carcinoma. Cancer. 1992;69:1088–93.CrossRefGoogle Scholar
  46. 46.
    Sabik JF, Rice TW, Goldblum JR, Koka A, Kirby TJ, Medendorp SV, Adelstein DJ. Superficial esophageal carcinoma. Ann Thorac Surg. 1995;60:896–901; discussion 2.CrossRefGoogle Scholar
  47. 47.
    Ormsby AH, Petras RE, Henricks WH, Riche TW, Richter JE, Goldblum JR. Interobserver variation in the diagnosis of superficial adenocarcinoma in Barrett’s esophagus. Mod Pathol. 1998;11:386A.Google Scholar
  48. 48.
    Lavery DL, Martinez P, Gay LJ, Cereser B, Novelli MR, Rodriguez-Justo M, Meijer SL, Graham TA, McDonald SA, Wright NA, Jansen M. Evolution of oesophageal adenocarcinoma from metaplastic columnar epithelium without goblet cells in Barrett’s oesophagus. Gut. 2016;65:907–13.CrossRefGoogle Scholar
  49. 49.
    Falk GW, Rice TW, Goldblum JR, Richter JE. Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc. 1999;49:170–6.CrossRefGoogle Scholar
  50. 50.
    Reid BJ, Haggitt RC, Rubin CE, Roth G, Surawicz CM, Van Belle G, Lewin K, Weinstein WM, Antonioli DA, Goldman H, et al. Observer variation in the diagnosis of dysplasia in Barrett’s esophagus. Hum Pathol. 1988;19:166–78.CrossRefGoogle Scholar
  51. 51.
    Montgomery E, Bronner MP, Goldblum JR, Greenson JK, Haber MM, Hart J, Lamps LW, Lauwers GY, Lazenby AJ, Lewin DN, Robert ME, Toledano AY, Shyr Y, Washington K. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001;32:368–78.CrossRefGoogle Scholar
  52. 52.
    Villanacci V, Salemme M, Stroppa I, Balassone V, Bassotti G. The importance of a second opinion in the diagnosis of Barrett’s esophagus: a “real life” study. Rev Esp Enferm Dig. 2017;109:185–9.PubMedGoogle Scholar
  53. 53.
    Ormsby AH, Goldblum JR, Rice TW, Richter JE, Falk GW, Vaezi MF, Gramlich TL. Cytokeratin subsets can reliably distinguish Barrett’s esophagus from intestinal metaplasia of the stomach. Hum Pathol. 1999;30:288–94.CrossRefGoogle Scholar
  54. 54.
    de Jonge PJ, van Blankenstein M, Looman CW, Casparie MK, Meijer GA, Kuipers EJ. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut. 2010;59:1030–6.CrossRefGoogle Scholar
  55. 55.
    Sjogren RW Jr, Johnson LF. Barrett’s esophagus: a review. Am J Med. 1983;74:313–21.CrossRefGoogle Scholar
  56. 56.
    Hamilton SR, Smith RR. The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett’s esophagus. Am J Clin Pathol. 1987;87:301–12.CrossRefGoogle Scholar
  57. 57.
    Lee RG. Dysplasia in Barrett’s esophagus. A clinicopathologic study of six patients. Am J Surg Pathol. 1985;9:845–52.CrossRefGoogle Scholar
  58. 58.
    Reid BJ, Blount PL, Rubin CE, Levine DS, Haggitt RC, Rabinovitch PS. Flow-cytometric and histological progression to malignancy in Barrett’s esophagus: prospective endoscopic surveillance of a cohort. Gastroenterology. 1992;102:1212–9.CrossRefGoogle Scholar
  59. 59.
    Schmidt HG, Riddell RH, Walther B, Skinner DB, Riemann JF. Dysplasia in Barrett’s esophagus. J Cancer Res Clin Oncol. 1985;110:145–52.CrossRefGoogle Scholar
  60. 60.
    Smith RR, Hamilton SR, Boitnott JK, Rogers EL. The spectrum of carcinoma arising in Barrett’s esophagus. A clinicopathologic study of 26 patients. Am J Surg Pathol. 1984;8:563–73.CrossRefGoogle Scholar
  61. 61.
    Hameeteman W, Tytgat GN, Houthoff HJ, van den Tweel JG. Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology. 1989;96:1249–56.CrossRefGoogle Scholar
  62. 62.
    Smith J, Garcia A, Zhang R, DeMeester S, Vallone J, Chandrasoma P. Intestinal metaplasia is present in most if not all patients who have undergone endoscopic mucosal resection for esophageal adenocarcinoma. Am J Surg Pathol. 2016;40:537–43.CrossRefGoogle Scholar
  63. 63.
    Schnell TG, Sontag SJ, Chejfec G. Adenocarcinomas arising in tongues or short segments of Barrett’s esophagus. Dig Dis Sci. 1992;37:137–43.CrossRefGoogle Scholar
  64. 64.
    Menke-Pluymers MB, Hop WC, Dees J, van Blankenstein M, Tilanus HW. Risk factors for the development of an adenocarcinoma in columnar-lined (Barrett) esophagus. The Rotterdam Esophageal Tumor Study Group. Cancer. 1993;72:1155–8.CrossRefGoogle Scholar
  65. 65.
    Sharma P, Weston AP, Morales T, Topalovski M, Mayo MS, Sampliner RE. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut. 2000;46:9–13.CrossRefGoogle Scholar
  66. 66.
    Morales TG, Camargo E, Bhattacharyya A, Sampliner RE. Long-term follow-up of intestinal metaplasia of the gastric cardia. Am J Gastroenterol. 2000;95:1677–80.CrossRefGoogle Scholar
  67. 67.
    Goldstein NS. Gastric cardia intestinal metaplasia: biopsy follow-up of 85 patients. Mod Pathol. 2000;13:1072–9.CrossRefGoogle Scholar
  68. 68.
    Reid BJ, Weinstein WM, Lewin KJ, Haggitt RC, VanDeventer G, DenBesten L, Rubin CE. Endoscopic biopsy can detect high-grade dysplasia or early adenocarcinoma in Barrett’s esophagus without grossly recognizable neoplastic lesions. Gastroenterology. 1988;94:81–90.CrossRefGoogle Scholar
  69. 69.
    Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O’Donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J, British Society of Group. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  70. 70.
    Naik AD, El-Serag HB. Endoscopic ablation of low-grade dysplasia in Barrett’s esophagus: have all the boxes been checked for us to move on? Gastrointest Endosc. 2017;86:130–2.CrossRefGoogle Scholar
  71. 71.
    Nguyen T, Thrift AP, Yu X, Duan Z, El-Serag HB. The annual risk of esophageal adenocarcinoma does not decrease over time in patients with Barrett’s esophagus. Am J Gastroenterol. 2017;112:1049–55.CrossRefGoogle Scholar
  72. 72.
    Petras RE, Sivak MV Jr, Rice TW. Barrett’s esophagus. A review of the pathologist’s role in diagnosis and management. Pathol Annu. 1991;26(Pt 2):1–32.PubMedGoogle Scholar
  73. 73.
    Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of Gastroenterology. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50; quiz 1.CrossRefGoogle Scholar
  74. 74.
    Mino-Kenudson M, Hull MJ, Brown I, Muzikansky A, Srivastava A, Glickman J, Park DY, Zuckerberg L, Misdraji J, Odze RD, Lauwers GY. EMR for Barrett’s esophagus-related superficial neoplasms offers better diagnostic reproducibility than mucosal biopsy. Gastrointest Endosc. 2007;66:660–6; quiz 767, 9.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Vincenzo Villanacci
    • 1
  • Karel Geboes
    • 2
  • Tiziana Salviato
    • 3
  • Gabrio Bassotti
    • 4
  1. 1.Institute of Pathology, Spedali CiviliBresciaItaly
  2. 2.Department of PathologyUniversity Hospitals Leuven, KU LeuvenLeuvenBelgium
  3. 3.Department of PathologyUniversity of Trieste—School of MedicineTriesteItaly
  4. 4.Gastroenterology and Hepatology Section, Department of MedicineUniversity of Perugia—School of MedicinePerugiaItaly

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