Columnar-lined Oesophagus (Barrett's Syndrome) - Congenital or Acquired?

Abstract

A segment of the distal esophagus lined with columnar epithelium (endobrachy esophagus, Barrett''s esophagus), is very frequently seen in association with chronic reflux conditions. This entity is usually an asymmetrical columnar cell metaplasia of varying extent, with an unsharp epithelial junction line cranial and showing varyingly large residual islands of squamous epithelium. Usually well-developed peptic lesions are also found. More rarely seen are cases with a longer, symmetrical, cranially sharply delimited columnar epithelial-lined segment, in which peptic lesions and strictures are usually restricted to the proximal section or are lacking altogether. Among more than 100 patients presented with endobrachy esophagus, 14 cases had the latter form of the condition. Seven had a solitary, high peptic stricture and only 50% unequivocal hiatal hernia. In 4 patients there were no inflammatory changes at all. In 8 patients, fundic glands were observed. Of particular interest was the segment-like arrangement of cardiac and fundic glands in 2 of the patients. In only a single case were scar formations seen in the columnar-lined segment. Certain forms of endobrachy esophagus apparently represent a congenital anomaly.