The columnar epithelial-lined lower esophagus and its association with adenocarcinoma of the esophagus.

Four cases of columnar epithelial-lined lower esophagus are presented. The condition can be complicated by esophagitis, ulceration, perforation, and adenocarcinoma of the esophagus. When the squamocolumnar junction is involved by peptic esophagitis, the area of mucosal transition appears as a tapered, strictured segment or a ring-line constriction some distance proximal to the muscular esophagogastric junction. Hiatal incompetence with massive gastroesophageal reflux was evident in 1 case. A deep penetrating ulcer may occur anywhere along the columnar epithelium, identical to peptic gastric ulceration. The columnar-lined lower esophagus should probably be considered a premalignant condition. Two of these patients had associated esophageal adenocarcinoma.