Abstract
Barrett esophagus is a well-recognized entity in which there is progressive columnar metaplasia of the lower esophagus due to longstanding gastroesophageal reflux and reflux esophagitis [1]. This condition is important because it is associated with an increased risk of developing esophageal adenocarcinoma by a well-established sequence from dysplasia to carcinoma [2]. During the past decade, however, an explosion of new data has dramatically affected our understanding of Barrett esophagus. Not only have revised histopathologic criteria been developed for this condition, but it is currently believed that patients with Barrett esophagus should be classified as having “short-segment” or “long-segment” disease based on the extent of columnar metaplasia in the distal esophagus. This distinction has important implications for the risk of developing esophageal adenocarcinoma and subsequent need for endoscopic surveillance. The purpose of this article is to present these new concepts about Barrett esophagus and provide radiologists with a more current framework for diagnosing this condition.
Similar content being viewed by others
References
SJ Spechler RK Goyal (1986) ArticleTitleBarrett’s esophagus N Engl J Med 315 362–371 Occurrence Handle1:STN:280:BimB1cvosFU%3D Occurrence Handle2874485
AP Naef M Savary L Ozzello (1975) ArticleTitleColumnar-lined lower esophagus: an acquired lesion with malignant predisposition: report on 140 cases of Barrett’s esophagus with 12 adenocarcinomas J Thorac Cardiovasc Surg 70 826–835
A Paull JS Trier MD Dalton et al. (1976) ArticleTitleThe histologic spectrum of Barrett’s esophagus N Engl J Med 295 476–480
WM Weinstein AF Ippoliti (1996) ArticleTitleThe diagnosis of Barrett’s esophagus: goblets, goblets, goblets Gastrointest Endosc 44 91–95 Occurrence Handle1:STN:280:BymH3sznsVM%3D Occurrence Handle8836727
SJ Spechler RK Goyal (1996) ArticleTitleThe columnar-lined esophagus, intestinal metaplasia, and Norman Barrett Gastroenterology 10 614–621
SR Hamilton RRL Smith (1987) ArticleTitleThe relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett’s esophagus Am J Clin Pathol 87 301–312
W Hameeteman GNJ Tytgat HJ Houthoff et al. (1989) ArticleTitleBarrett’s esophagus: development of dysplasia and adenocarcinoma Gastroenterology 96 1249–1256
P Sharma TG Morales RE Sampliner (1998) ArticleTitleShort segment Barrett’s esophagus—the need for standardization of the definition and of endoscopic criteria Am J Gastroenterol 93 1033–1036 Occurrence Handle10.1016/S0002-9270(98)00205-6 Occurrence Handle1:STN:280:DyaK1czjs1Sluw%3D%3D Occurrence Handle9672325
SJ Spechler (2002) ArticleTitleBarrett’s esophagus N Engl J Med 346 836–842 Occurrence Handle10.1056/NEJMcp012118 Occurrence Handle11893796
D Donahue F Navab (1997) ArticleTitleSignificance of short-segment Barrett’s esophagus J Clin Gastroenterol 25 480–484
P Sharma (1999) ArticleTitleRecent advances in Barrett’s esophagus: short-segment Barrett’s esophagus and cardia intestinal metaplasia Semin Gastrointest Dis 10 93–102
WK Hirota TM Loughney DJ Lazas et al. (1999) ArticleTitleSpecialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data Gastroenterology 116 277–285 Occurrence Handle1:STN:280:DyaK1M7it12msg%3D%3D Occurrence Handle9922307
S Nandurkar NJ Talley (1999) ArticleTitleBarrett’s esophagus: the long and the short of it Am J Gastroenterol 94 30–40 Occurrence Handle10.1016/S0002-9270(98)00649-2 Occurrence Handle1:STN:280:DyaK1M7jtFChtQ%3D%3D Occurrence Handle9934728
SR DeMeester TR DeMeester (2000) ArticleTitleColumnar mucosa and intestinal metaplasia of the esophagus: fifty years of controversy Ann Surg 231 303–321 Occurrence Handle10.1097/00000658-200003000-00003 Occurrence Handle1:STN:280:DC%2BD3c7nslWjtw%3D%3D Occurrence Handle10714623
LB Gerson K Shetler G Triadafilopoulos (2002) ArticleTitlePrevalence of Barrett’s esophagus in asymptomatic individuals Gastroenterology 123 461–467
C Winters TJ Spurling SJ Chobanian et al. (1987) ArticleTitleBarrett’s esophagus: a prevalent, occult complication of gastroesophageal reflux disease Gastroenterology 92 118–124
DB Skinner BC Walther RH Riddell et al. (1983) ArticleTitleBarrett’s esophagus: comparison of benign and malignant cases Ann Surg 198 554–566
MG Sarr SR Hamilton GC Marrone JL Cameron (1985) ArticleTitleBarrett’s esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux Am J Surg 149 187–192
BJ Reid (1991) ArticleTitleBarrett’s esophagus and esophageal adenocarcinoma Gastroenterol Clin North Am 20 817–834
FG Duhaylongsod WG Wolfe (1991) ArticleTitleBarrett’s esophagus and adenocarcinoma of the esophagus and gastroesophageal junction J Thorac Cardiovasc Surg 102 36–42
H Li TN Walsh TPJ Hennessy (1992) ArticleTitleCarcinoma arising in Barrett’s esophagus Surg Gynecol Obstet 175 167–172
MS Levine JB Herman EE Furth (1995) ArticleTitleBarrett’s esophagus and esophageal adenocarcinoma: the scope of the problem Abdom Imaging 20 291–298
J Lagergren R Bergstrom A Lindgren O Nyren (1999) ArticleTitleSymptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma N Engl J Med 340 825–831 Occurrence Handle10.1056/NEJM199903183401101 Occurrence Handle1:STN:280:DyaK1M7msFeitw%3D%3D Occurrence Handle10080844
NJ Shaheen MA Crosby EM Bozymski RS Sandler (2000) ArticleTitleIs there publication bias in the reporting of cancer risk in Barrett’s esophagus? Gastroenterology 119 333–338
RE Sampliner (1998) ArticleTitlePractice Parameters Committee on the American College of Gastroenterology. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett’s esophagus Am J Gastroenterol 93 1028–1032 Occurrence Handle10.1016/S0002-9270(98)00243-3 Occurrence Handle1:STN:280:DyaK1czjs1Slug%3D%3D Occurrence Handle9672324
P Kruse S Boesby IT Bernstein IB Andersen (1993) ArticleTitleBarrett’s esophagus and esophageal adenocarcinoma: endoscopic and histologic surveillance Scand J Gastroenterol 28 193–196
BJ Reid DS Levine G Longton et al. (2000) ArticleTitlePredictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets Am J Gastroenterol 95 1669–1676
NS Buttar KK Wang TJ Sebo et al. (2001) ArticleTitleExtent of high-grade dysplasia in Barrett’s esophagus correlates with risk of adenocarcinoma Gastroenterology 120 1630–1639
J Boogert Particlevan den R Hillegersberg Particlevan PD Siersema et al. (1999) ArticleTitleEndoscopic ablation therapy for Barrett’s esophagus with high-grade dysplasia: a review Am J Gastroenterol 94 1153–1160
BF Overholt M Panjehpour JM Haydek (1999) ArticleTitlePhotodynamic therapy for Barrett’s esophagus: follow-up in 100 patients Gastrointest Endosc 49 1–7
E Achkar W Carey (1988) ArticleTitleThe cost of surveillance for adenocarcinoma complicating Barrett’s esophagus Am J Gastroenterol 83 291–294
JM Streitz CW Andrews H Ellis (1993) ArticleTitleEndoscopic surveillance of Barrett’s esophagus: does it help? J Thorac Cardiovasc Surg 105 383–388
D Provenzale JA Kemp S Arora JB Wong (1994) ArticleTitleA guide for surveillance of patients with Barrett’s esophagus Am J Gastroenterol 89 670–680 Occurrence Handle1:STN:280:ByuB38ngvF0%3D Occurrence Handle8172136
MM Missakian HC Carlson HA Andersen (1967) ArticleTitleThe roentgenologic features of the columnar epithelial-lined lower esophagus AJR 99 212–217
AH Robbins JA Hermos EM Schimmel et al. (1977) ArticleTitleThe columnar-lined esophagus: analysis of 26 cases Radiology 123 1–7
YM Chen DW Gelfand DJ Ott WC Wu (1985) ArticleTitleBarrett esophagus as an extension of severe esophagitis: analysis of radiologic signs in 29 cases AJR 145 275–281 Occurrence Handle1:STN:280:BiqB2srotVE%3D Occurrence Handle3875227
SN Glick (1994) ArticleTitleBarium studies in patients with Barrett’s esophagus: importance of focal areas of esophageal deformity AJR 163 65–67
AH Robbins ME Vincent M Saini EM Schimmel (1978) ArticleTitleRevised radiologic concepts of Barrett esophagus Gastrointest Radiol 3 377–381
J Shapir R DuBrow P Frank (1985) ArticleTitleBarrett oesophagus: analysis of 19 cases Br J Radiol 58 491–493
FP Agha (1986) ArticleTitleRadiologic diagnosis of Barrett’s esophagus: critical analysis of 65 cases Gastrointest Radiol 11 123–130
MS Levine HY Kressel DF Caroline et al. (1983) ArticleTitleBarrett esophagus: reticular pattern of the mucosa Radiology 147 663–667 Occurrence Handle1:STN:280:BiyC1MrotVQ%3D Occurrence Handle6844601
MM Chernin JR Amberg FJ Kogan et al. (1986) ArticleTitleEfficacy of radiologic studies in the detection of Barrett’s esophagus AJR 147 257–260
AM Gilchrist MS Levine RF Carr et al. (1988) ArticleTitleBarrett’s esophagus: diagnosis by double-contrast esophagography AJR 150 97–102
AJ Cameron CT Lomboy (1992) ArticleTitleBarrett’s esophagus: age, prevalence, and extent of columnar epithelium Gastroenterology 103 1241–1245 Occurrence Handle1:STN:280:ByyD3M3mvFw%3D Occurrence Handle1397881
MH Johnston AS Hammond W Laskin DM Jones (1996) ArticleTitleThe prevalence and clinical characteristics of short-segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy Am J Gastroenterol 91 1507–1511
P Sharma TG Morales A Bhattacharyya et al. (1997) ArticleTitleDysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up Am J Gastroenterol 92 2012–2016
AP Weston PT Krmpotich R Cherian et al. (1997) ArticleTitleProspective long-term endoscopic and histological follow-up of short-segment Barrett’s esophagus: comparison with traditional long-segment Barrett’s esophagus Am J Gastroenterol 92 407–413
B O’Connor FW Falk JE Richter (1999) ArticleTitleThe incidence of adenocarcinoma and dysplasia in Barrett’s esophagus Am J Gastroenterol 94 2037–2042
TG Schnell SJ Sontag G Chejfec (1992) ArticleTitleAdenocarcinomas arising in tongues or short-segments of Barrett’s esophagus Dig Dis Sci 37 137–143
T Nishimaki K Watanabe T Suzuki et al. (1996) ArticleTitleEarly esophageal adenocarcinoma arising in a short-segment of Barrett’s mucosa after total gastrectomy Am J Gastroenterol 91 1856–1857
S Nandurkar CJ Martin NJ Talley JM Wyatt (1998) ArticleTitleCurable cancer in a short-segment Barrett’s esophagus Dis Esoph 11 284–287
AJ Yamamoto MS Levine DA Katzka et al. (2001) ArticleTitleShort-segment Barrett’s esophagus: findings on double-contrast esophagography in 20 patients AJR 176 1173–1178
JR Goldblum JJ Vicari GY Falk et al. (1998) ArticleTitleInflammation and intestinal metaplasia of the gastric cardia: the role of gastroesophageal reflux disease and H. pylori infection Gastroenterology 114 633–639 Occurrence Handle1:STN:280:DyaK1c7osVOruw%3D%3D Occurrence Handle9516382
SJ Spechler JM Zeroogian DA Antonioli et al. (1994) ArticleTitlePrevalence of metaplasia at the gastro-oesophageal junction Lancet 344 1533–1536 Occurrence Handle10.1016/S0140-6736(94)90349-2
N Chalasani JM Wo JG Hunter JP Waring (1997) ArticleTitleSignificance of intestinal metaplasia in different areas of esophagus including esophagogastric junction Dig Dis Sci 42 603–607
TG Morales RE Sampliner A Bhattacharyya (1997) ArticleTitleIntestinal metaplasia of the gastric cardia Am J Gastroenterol 92 414–418
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Levine, M.S. Barrett esophagus: update for radiologists. Abdom Imaging 30, 133–141 (2005). https://doi.org/10.1007/s00261-004-0209-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-004-0209-0