Historical Perspective: Evolution of the Diagnosis and Management of Barrett’s Esophagus

  • Reginald C. W. BellEmail author


The history of Barrett’s esophagus provides insight into current understanding not only of esophageal cancer but also of the anatomy and physiology of hiatal hernia and GERD. A current definition of Barrett’s esophagus is “the condition in which metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus and predisposes to cancer development.” Although straightforward, the definition of and ability to precisely identify the esophagogastric junction and agreement on what constitutes metaplastic epithelium that predispose to cancer development remain problematic. Barrett’s esophagus is characterized by a metaplastic epithelium in the distal esophagus which may (or may not) be visualized as columnar epithelium during flexible endoscopy. To understand the history, definition, and current controversies surrounding Barrett’s esophagus requires an understanding of what defines the gastroesophageal junction and the various histologies present in this region.


Barrett’s esophagus Esophageal cancer GERD 


  1. 1.
    Allison PR. Peptic ulcer of the oesophagus. Thorax. 1948;3:20–42.CrossRefGoogle Scholar
  2. 2.
    Allison PR, Johnstone AS. The oesophagus lined with gastric mucous membrane. Thorax. 1953;8:87–101.CrossRefGoogle Scholar
  3. 3.
    Barrett NR. Chronic peptic ulcer of the oesophagus and ‘oesophagitis’. Br J Surg. 1950;38:175–82.CrossRefGoogle Scholar
  4. 4.
    Barrett NR. The lower esophagus lined by columnar epithelium. Surgery. 1957;41:881–94.PubMedGoogle Scholar
  5. 5.
    Belladonna JA, Hajdu SI, Bains MS, Winawer SJ. Adenocarcinoma in situ of Barrett’s esophagus diagnosed by endoscopic cytology. N Engl J Med. 1974;291:895–6.CrossRefGoogle Scholar
  6. 6.
    Bosher LH, Taylor FH. Heterotopic gastric mucosa in the esophagus with ulceration and stricture formation. J Thorac Surg. 1951;21:306–12.PubMedGoogle Scholar
  7. 7.
    Brandt LJ, Kauvar DR. Laser-induced transient regression of Barrett’s epithelium. Gastrointest Endosc. 1992;38:619–22.CrossRefGoogle Scholar
  8. 8.
    Bremner CG, Lynch VP, Ellis FH Jr. Barrett’s esophagus: congenital or acquired? An experimental study of esophageal mucosal regeneration in the dog. Surgery. 1970;68:209–16.PubMedGoogle Scholar
  9. 9.
    Chandrasoma P. Pathophysiology of Barrett’s esophagus. Semin Thorac Cardiovasc Surg. 1997;9:270–8.PubMedGoogle Scholar
  10. 10.
    Chandrasoma PD, Demeester TR. GERD: Reflux to Adenocarcinoma. Amsterdam: Elsevier; 2006.Google Scholar
  11. 11.
    Chandrasoma PT, Lokuhetty DM, Demeester TR, Bremmer CG, Peters JH, Oberg S, Groshen S. Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol. 2000;24:344–51.CrossRefGoogle Scholar
  12. 12.
    Clark GW, Ireland AP, Peters JH, Chandrasoma P, Demeester TR, Bremner CG. Short-segment Barrett’s esophagus: a prevalent complication of gastroesophageal reflux disease with malignant potential. J Gastrointest Surg. 1997;1:113–22.CrossRefGoogle Scholar
  13. 13.
    Clark GW, Smyrk TC, Burdiles P, Hoeft SF, Peters JH, Kiyabu M, Hinder RA, Bremner CG, Demeester TR. Is Barrett’s metaplasia the source of adenocarcinomas of the cardia? Arch Surg. 1994;129:609–14.CrossRefGoogle Scholar
  14. 14.
    Fitzgerald RC, di Pietro M, Ragunath K, Ang Y, Kang JY, Watson P, Trudgill N, Patel P, Kaye PV, Sanders S, O’donovan M, Bird-Lieberman E, Bhandari P, Jankowski JA, Attwood S, Parsons SL, Loft D, Lagergren J, Moayyedi P, Lyratzopoulos G, de Caestecker J, British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  15. 15.
    Hahn HP, Blount PL, Ayub K, Das KM, Souza R, Spechler S, Odze RD. Intestinal differentiation in metaplastic, nongoblet columnar epithelium in the esophagus. Am J Surg Pathol. 2009;33:1006–15.CrossRefGoogle Scholar
  16. 16.
    Hankins JR, Cole FN, Attar S, Frost JL, McLaughlin JS. Adenocarcinoma involving the esophagus. J Thorac Cardiovasc Surg. 1974;68:148–58.PubMedGoogle Scholar
  17. 17.
    Hayward J. The lower end of the oesophagus. Thorax. 1961;16:36–41.CrossRefGoogle Scholar
  18. 18.
    Jankowski JA, Wright NA, Meltzer SJ, Triadafilopoulos G, Geboes K, Casson AG, Kerr D, Young LS. Molecular evolution of the metaplasia-dysplasia-adenocarcinoma sequence in the esophagus. Am J Pathol. 1999;154:965–73.CrossRefGoogle Scholar
  19. 19.
    Liu W, Hahn H, Odze RD, Goyal RK. Metaplastic esophageal columnar epithelium without goblet cells shows DNA content abnormalities similar to goblet cell-containing epithelium. Am J Gastroenterol. 2009;104:816–24.CrossRefGoogle Scholar
  20. 20.
    Lord RV. Norman Barrett, “doyen of esophageal surgery”. Ann Surg. 1999;229:428–39.CrossRefGoogle Scholar
  21. 21.
    McClave SA, Boyce HW Jr, Gottfried MR. Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc. 1987;33:413–6.CrossRefGoogle Scholar
  22. 22.
    Miehlke S, Morgner A, Aust D, Madisch A, Vieth M, Baretton G. Combined use of narrow-band imaging magnification endoscopy and miniprobe confocal laser microscopy in neoplastic Barrett’s esophagus. Endoscopy. 2007;39(Suppl 1):E316.CrossRefGoogle Scholar
  23. 23.
    Morson BC, Belcher JR. Adenocarcinoma of the oesophagus and ectopic gastric mucosa. Br J Cancer. 1952;6:127–30.CrossRefGoogle Scholar
  24. 24.
    Murphy SJ, Johnston BT, Murray LJ. British Society of Gastroenterology guidelines for the diagnosis of Barrett’s oesophagus: are we casting the net too wide? Gut. 2006;55:1821–2.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Nandurkar S, Talley NJ, Martin CJ, Ng TH, Adams S. Short segment Barrett’s oesophagus: prevalence, diagnosis and associations. Gut. 1997;40:710–5.CrossRefGoogle Scholar
  26. 26.
    Oberg S, Clark GW, Demeester TR. Barrett’s esophagus. Update of pathophysiology and management. Hepato-Gastroenterology. 1998;45:1348–56.PubMedGoogle Scholar
  27. 27.
    Overholt BF, Wang KK, Burdick JS, Lightdale CJ, Kimmey M, Nava HR, Sivak MV Jr, Nishioka N, Barr H, Marcon N, Pedrosa M, Bronner MP, Grace M, Depot M, International Photodynamic Group for High-Grade Dysplasia In Barrett’s Esophagus. Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett’s high-grade dysplasia. Gastrointest Endosc. 2007;66:460–8.CrossRefGoogle Scholar
  28. 28.
    Owen DA. Stomach. In: Sternberg SS, editor. Histology for pathologists. 2nd ed. Philadelphia: Lippincott-Raven Publishers; 1997.Google Scholar
  29. 29.
    Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett’s esophagus. N Engl J Med. 1976;295:476–80.CrossRefGoogle Scholar
  30. 30.
    Reid BJ. Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterol Clin N Am. 1991;20:817–34.Google Scholar
  31. 31.
    Rex DK, Cummings OW, Shaw M, Cumings MD, Wong RK, Vasudeva RS, Dunne D, Rahmani EY, Helper DJ. Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn. Gastroenterology. 2003;125:1670–7.CrossRefGoogle Scholar
  32. 32.
    Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, Vieth M, Stolte M, Talley NJ, Agreus L. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–31.CrossRefGoogle Scholar
  33. 33.
    Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett’s esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996;44:532–5.CrossRefGoogle Scholar
  34. 34.
    Sampliner RE, Hixson LJ, Fennerty MB, Garewal HS. Regression of Barrett’s esophagus by laser ablation in an anacid environment. Dig Dis Sci. 1993;38:365–8.CrossRefGoogle Scholar
  35. 35.
    Seery JP. Stem cells of the oesophageal epithelium. J Cell Sci. 2002;115:1783–9.PubMedGoogle Scholar
  36. 36.
    Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373:850–61.CrossRefGoogle Scholar
  37. 37.
    Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, Jobe BA, Eisen GM, Fennerty MB, Hunter JG, Fleischer DE, Sharma VK, Hawes RH, Hoffman BJ, Rothstein RI, Gordon SR, Mashimo H, Chang KJ, Muthusamy VR, Edmundowicz SA, Spechler SJ, Siddiqui AA, Souza RF, Infantolino A, Falk GW, Kimmey MB, Madanick RD, Chak A, Lightdale CJ. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.CrossRefGoogle Scholar
  38. 38.
    Sharma P. Recent advances in Barrett’s esophagus: short-segment Barrett’s esophagus and cardia intestinal metaplasia. Semin Gastrointest Dis. 1999;10:93–102.PubMedGoogle Scholar
  39. 39.
    Sharma P, McQuaid K, Dent J, Fennerty MB, Sampliner R, Spechler S, Cameron A, Corley D, Falk G, Goldblum J, Hunter J, Jankowski J, Lundell L, Reid B, Shaheen NJ, Sonnenberg A, Wang K, Weinstein W, AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology. 2004;127:310–30.CrossRefGoogle Scholar
  40. 40.
    Sharma P, Morales TG, Bhattacharyya A, Garewal HS, Sampliner RE. Dysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up. Am J Gastroenterol. 1997;92:2012–6.PubMedGoogle Scholar
  41. 41.
    Skinner DB, Walther BC, Riddell RH, Schmidt H, Iascone C, Demeester TR. Barrett’s esophagus. Comparison of benign and malignant cases. Ann Surg. 1983;198:554–65.CrossRefGoogle Scholar
  42. 42.
    Spechler SJ, Fitzgerald RC, Prasad GA, Wang KK. History, molecular mechanisms, and endoscopic treatment of Barrett’s esophagus. Gastroenterology. 2010;138:854–69.CrossRefGoogle Scholar
  43. 43.
    Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ, American Gastroenterological, Association. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–52; quiz e13.CrossRefGoogle Scholar
  44. 44.
    Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-oesophageal junction. Lancet. 1994;344:1533–6.CrossRefGoogle Scholar
  45. 45.
    Stein HJ, von Rahden BH, Hofler H, Siewert JR. Carcinoma of the oesophagogastric junction and Barrett’s esophagus: an almost clear oncologic model? Chirurg. 2003;74:703–8.CrossRefGoogle Scholar
  46. 46.
    Takubo K, Aida J, Naomoto Y, Sawabe M, Arai T, Shiraishi H, Matsuura M, Ell C, May A, Pech O, Stolte M, Vieth M. Cardiac rather than intestinal-type background in endoscopic resection specimens of minute Barrett adenocarcinoma. Hum Pathol. 2009;40:65–74.CrossRefGoogle Scholar
  47. 47.
    Tileston W. Peptic ulcer of the oesophagus. Am J Med Sci. 1906;132:240–65.CrossRefGoogle Scholar
  48. 48.
    Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20; quiz 1943CrossRefGoogle Scholar
  49. 49.
    Wang KK, Sampliner RE, Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008;103:788–97.CrossRefGoogle Scholar
  50. 50.
    Weston AP, Krmpotich P, Makdisi WF, Cherian R, Dixon A, McGregor DH, Banerjee SK. Short segment Barrett’s esophagus: clinical and histological features, associated endoscopic findings, and association with gastric intestinal metaplasia. Am J Gastroenterol. 1996;91:981–6.PubMedGoogle Scholar
  51. 51.
    Weston AP, Krmpotich PT, Cherian R, Dixon A, Topalosvki M. Prospective long-term endoscopic and histological follow-up of short segment Barrett’s esophagus: comparison with traditional long segment Barrett’s esophagus. Am J Gastroenterol. 1997;92:407–13.PubMedGoogle Scholar

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© SAGES 2019

Authors and Affiliations

  1. 1.Institute of Esophageal and Reflux SurgeryEnglewoodUSA

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