Short and ultrashort Barrett's esophagus--what does it mean?

Most studies on Barrett's esophagus have included patients with severe gastroesophageal reflux disease (GERD) for whom endoscopic examinations revealed long segments of columnar epithelium extending well above the esophagogastric junction. Biopsy specimens of this extensive columnar lining have usually revealed an incomplete form of intestinal metaplasia (specialized intestinal metaplasia) that has been shown to predispose to the development of adenocarcinoma. Recent studies suggest that short segments of specialized intestinal metaplasia can be found in approximately 20% of white adults undergoing elective endoscopic examinations in a general endoscopy unit, regardless of the indication for the procedure. This condition has been called "short-segment Barrett's esophagus," although "columnar lined esophagus with intestinal metaplasia" may be a more appropriate terminology for reasons discussed in detail later. Specialized intestinal metaplasia can be found in one third to one half of patients whose squamocolumnar junction appears jagged, irregular, or especially prominent. However, up to 15% of patients with a healthy-appearing squamocolumnar junction, exhibiting none of the aforementioned features, harbor small foci of intestinal metaplasia at the esophagogastric junction. Unlike patients with traditional (long-segment) Barrett's esophagus, many patients with short segments of intestinal metaplasia in the distal esophagus have no signs of GERD. Furthermore, these short segments do not appear to be as predisposed to malignancy as are long segments of intestinal metaplasia in the esophagus. Until the cancer risk is better defined, it is not recommended that endoscopists routinely obtain biopsy specimens from a healthy-appearing distal esophagus to look for specialized intestinal metaplasia.