Pathology of Barrett's Esophagus

1. Multilayered Epithelium:

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Multilayered epithelium is composed of squamoid cells at the base and columnar cells at the top. It has been noted in Barrett’s esophagus and carditis related to GERD, but not H. pylori infection. It may represent a transitional stage in the development of Barrett's esophagus. See references:

Odze, RD, et al., Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas (Philadelphia, PA: Saunders, 2004)

Shields HM, Rosenberg SJ et al., “Prospective evaluation of multilayered epithelium in Barrett's esophagus,” Am J Gastroenterol. 2001 Dec; 96(12):3268-73

Patient A: 70 year old female with a long history of heartburn. Endoscopy showed a large Hiatal hernia and a 7 cm segment columnar mucosa.

2. Barrett’s esophagus (low power):

Figure 1

Slightly villiform glandular mucosa with intestinal metaplasia and antral type gastric glands has replaced the normal squamous mucosa of the esophagus. The intestinal metaplasia is established by the presence of the goblet cells with the distinctly ovoid mucin droplets, in comparison to the smaller mucin vacuoles of the foveolar mucinous cells. This type of intestinal metaplasia is considered incomplete type. In complete type of intestinal metaplasia, goblets cells, as well as small intestinal absorptive cells characterize the epithelium.

3. Barrett’s esophagus (high power):

Figure 2

Incomplete intestinal metaplasia: goblet cells and foveolar gastric type epithelium cells.

4. Barrett’s esophagus (high power):

Figure 3

Goblet cells are also identified by their content of acid mucins, made visible by the blue staining reaction with alcian blue at pH 2.5.

Pathology slides of our patients were provided by Dr. James P. Kolton of Caritas Norwood Hospital, Norwood, MA.