Barrett's Esophagus: A Comprehensive and Contemporary Review for Pathologists

Overview

Journal Am J Surg Pathol

Date 2016 Jan 28

PMID 26813745

Citations 52

Authors

Bita V Naini

Rhonda F Souza

Robert D Odze

Affiliations

Soon will be listed here.

Abstract

This review provides a summary of our current understanding of, and the controversies surrounding, the diagnosis, pathogenesis, histopathology, and molecular biology of Barrett's esophagus (BE) and associated neoplasia. BE is defined as columnar metaplasia of the esophagus. There is worldwide controversy regarding the diagnostic criteria of BE, mainly with regard to the requirement to histologically identify goblet cells in biopsies. Patients with BE are at increased risk for adenocarcinoma, which develops in a metaplasia-dysplasia-carcinoma sequence. Surveillance of patients with BE relies heavily on the presence and grade of dysplasia. However, there are significant pathologic limitations and diagnostic variability in evaluating dysplasia, particularly with regard to the more recently recognized unconventional variants. Identification of non-morphology-based biomarkers may help risk stratification of BE patients, and this is a subject of ongoing research. Because of recent achievements in endoscopic therapy, there has been a major shift in the treatment of BE patients with dysplasia or intramucosal cancer away from esophagectomy and toward endoscopic mucosal resection and ablation. The pathologic issues related to treatment and its complications are also discussed in this review article.

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References

Ormsby A, Goldblum J, Rice T, Richter J, Falk G, Vaezi M . Cytokeratin subsets can reliably distinguish Barrett's esophagus from intestinal metaplasia of the stomach. Hum Pathol. 1999; 30(3):288-94. DOI: 10.1016/s0046-8177(99)90007-2. View

Rioux-Leclercq N, Turlin B, Sutherland F, Heresbach N, Launois B, Campion J . Analysis of Ki-67, p53 and Bcl-2 expression in the dysplasia-carcinoma sequence of Barrett's esophagus. Oncol Rep. 1999; 6(4):877-82. DOI: 10.3892/or.6.4.877. View

Thurberg B, Duray P, Odze R . Polypoid dysplasia in Barrett's esophagus: a clinicopathologic, immunohistochemical, and molecular study of five cases. Hum Pathol. 1999; 30(7):745-52. DOI: 10.1016/s0046-8177(99)90134-x. View

Yin J, Harpaz N, Souza R, Zou T, Kong D, Wang S . Low prevalence of the APC I1307K sequence in Jewish and non-Jewish patients with inflammatory bowel disease. Oncogene. 1999; 18(26):3902-4. DOI: 10.1038/sj.onc.1202638. View

Younes M, Schwartz M, Ertan A, Finnie D, Younes A . Fas ligand expression in esophageal carcinomas and their lymph node metastases. Cancer. 2000; 88(3):524-8. View

Chen Y, Wang H, Antonioli D, Spechler S, Zeroogian J, Goyal R . Significance of acid-mucin-positive nongoblet columnar cells in the distal esophagus and gastroesophageal junction. Hum Pathol. 2000; 30(12):1488-95. DOI: 10.1016/s0046-8177(99)90172-7. View

Ormsby A, Kilgore S, Goldblum J, Richter J, Rice T, Gramlich T . The location and frequency of intestinal metaplasia at the esophagogastric junction in 223 consecutive autopsies: implications for patient treatment and preventive strategies in Barrett's esophagus. Mod Pathol. 2000; 13(6):614-20. DOI: 10.1038/modpathol.3880106. View

Reid B, Levine D, Longton G, Blount P, Rabinovitch P . Predictors of progression to cancer in Barrett's esophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol. 2000; 95(7):1669-76. PMC: 1783835. DOI: 10.1111/j.1572-0241.2000.02196.x. View

Lord R, Ogrady R, Sheehan C, Field A, Ward R . K-ras codon 12 mutations in Barrett's oesophagus and adenocarcinomas of the oesophagus and oesophagogastric junction. J Gastroenterol Hepatol. 2000; 15(7):730-6. DOI: 10.1046/j.1440-1746.2000.02163.x. View

10.

Weston A, Sharma P, Topalovski M, Richards R, Cherian R, Dixon A . Long-term follow-up of Barrett's high-grade dysplasia. Am J Gastroenterol. 2000; 95(8):1888-93. DOI: 10.1111/j.1572-0241.2000.02234.x. View

11.

Bhargava P, Eisen G, Holterman D, Azumi N, Hartmann D, Hanfelt J . Endoscopic mapping and surrogate markers for better surveillance in Barrett esophagus. A study of 700 biopsy specimens. Am J Clin Pathol. 2000; 114(4):552-63. DOI: 10.1309/93WG-ERRB-PN57-C15A. View

12.

Goldstein N . Gastric cardia intestinal metaplasia: biopsy follow-up of 85 patients. Mod Pathol. 2000; 13(10):1072-9. DOI: 10.1038/modpathol.3880198. View

13.

Souza R, Shewmake K, Beer D, Cryer B, Spechler S . Selective inhibition of cyclooxygenase-2 suppresses growth and induces apoptosis in human esophageal adenocarcinoma cells. Cancer Res. 2000; 60(20):5767-72. View

14.

Skacel M, Petras R, Gramlich T, Sigel J, Richter J, Goldblum J . The diagnosis of low-grade dysplasia in Barrett's esophagus and its implications for disease progression. Am J Gastroenterol. 2001; 95(12):3383-7. DOI: 10.1111/j.1572-0241.2000.03348.x. View

15.

Montgomery E, Bronner M, Goldblum J, Greenson J, Haber M, Hart J . Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001; 32(4):368-78. DOI: 10.1053/hupa.2001.23510. View

16.

Glickman J, Chen Y, Wang H, Antonioli D, Odze R . Phenotypic characteristics of a distinctive multilayered epithelium suggests that it is a precursor in the development of Barrett's esophagus. Am J Surg Pathol. 2001; 25(5):569-78. DOI: 10.1097/00000478-200105000-00002. View

17.

Graham D . Cytokeratin subsets for distinguishing Barrett's esophagus from intestinal metaplasia in the cardia using endoscopic biopsy specimens. Am J Gastroenterol. 2001; 96(5):1378-82. DOI: 10.1111/j.1572-0241.2001.03792.x. View

18.

Buttar N, Wang K, Sebo T, Riehle D, Krishnadath K, Lutzke L . Extent of high-grade dysplasia in Barrett's esophagus correlates with risk of adenocarcinoma. Gastroenterology. 2001; 120(7):1630-9. DOI: 10.1053/gast.2001.25111. View

19.

Shureiqi I, Xu X, Chen D, Lotan R, Morris J, Fischer S . Nonsteroidal anti-inflammatory drugs induce apoptosis in esophageal cancer cells by restoring 15-lipoxygenase-1 expression. Cancer Res. 2001; 61(12):4879-84. View

20.

Salmela M, Karjalainen-Lindsberg M, Puolakkainen P, Saarialho-Kere U . Upregulation and differential expression of matrilysin (MMP-7) and metalloelastase (MMP-12) and their inhibitors TIMP-1 and TIMP-3 in Barrett's oesophageal adenocarcinoma. Br J Cancer. 2001; 85(3):383-92. PMC: 2364078. DOI: 10.1054/bjoc.2001.1929. View