Barrett's esophagus.

Barrett's esophagus remains an interesting but incompletely understood entity. Although most authors contend that it is of acquired origin, evidence is presented to substantiate either an acquired or a congenital origin. The possibility exists that Barrett's esophagus may be acquired in some instances and congenital in others. The most characteristic, albeit not exclusive, histologic features of Barrett's esophagus are defined by the presence of three types of columnar epithelium: an atrophic gastric fundic type of epithelium, a junctional type of epithelium and a specialized columnar epithelium. Reversion of columnar epithelium to squamous epithelium after successful antireflux operation demands further confirmation and study. Dysplastic, metaplastic and adenomatous changes in Barrett's esophagus do occur and must be observed carefully with endoscopy during the follow-up period. The possible relationship between these changes and malignant degeneration requires further study. Although the clinical presentation of benign complications occurring in a Barrett's esophagus simulates those occurring with reflux peptic esophagitis, distinctive roentgenographic and endoscopic features suggest the diagnosis. Treatment of the complications of Barrett's esophagus is essentially surgical, although cimetidine has been shown to be effective for healing of Barrett's ulcer. The need remains for further definition and clarification of the natural history of Barrett's esophagus so that its management can be based upon more definitive grounds.