Barrett's Esophagus

Definition

Barrett's esophagus is a condition in which the normal squamous epithelium of the distal esophagus is replaced by specialized intestinal columnar epithelium (intestinal metaplasia), usually due to chronic gastroesophageal reflux disease (GERD).

Epidemiology

• Prevalence: 1–2% of the general population, up to 10–15% in patients with chronic GERD
• More common in males (3:1) and Caucasians
• Typically diagnosed in middle-aged to older adults (50–60 years)
• Associated with obesity, hiatal hernia, and smoking

Etiology

• Chronic gastroesophageal reflux disease (GERD) causing repeated mucosal injury
• Obesity, particularly central adiposity
• Hiatal hernia contributing to reflux
• Smoking and alcohol consumption
• Genetic susceptibility in some families

Pathophysiology

• Chronic acid and bile reflux → injury to squamous epithelium → repair by intestinal-type columnar epithelium (intestinal metaplasia)
• Metaplasia may progress to dysplasia → increased risk of esophageal adenocarcinoma
• Inflammatory cytokines and oxidative stress contribute to epithelial transformation
• Progression risk: non-dysplastic → low-grade dysplasia → high-grade dysplasia → adenocarcinoma