Barrett esophagus is a condition in which intestinal metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of chronic gastroesophageal reflux disease (GERD) due to lower esophageal sphincter (LES) dysfunction.
Barrett esophagus carries a 0.5% yearly risk of esophageal adenocarcinoma, a 30- to 50-fold increased risk compared to patients without Barrett esophagus. Risk factors for Barret esophagus include white ethnicity, advanced age, obesity, smoking, hiatal hernia, and long duration of GERD symptoms. Barrett esophagus may also occur in patients without prior reflux symptoms. This may be due to decreased acid sensitivity of the metaplastic columnar epithelium at the distal esophagus. Management involves endoscopic surveillance to look for low- or high-grade dysplasia or adenocarcinoma.