This esophageal biopsy in a patient with long-standing reflux symptoms is indicative of which of the following? 

A. a condition requiring anti-reflux measures and surveillance endoscopy
B. a condition requiring esophagectomy
C. a condition that will resolve following fundoplication
D. a lesion associated with a 20% incidence of invasive carcinoma
E. a lesion limited to the distal 5 cm of the esophagus

Answer A

The photomicrograph shows Barrett's mucosa, a condition defined as columnar epithelium at a distance 3 cm or greater above the gastroesophageal junction. There are three histologic types of Barrett's epithelium: gastric, junctional, and specialized columnar or intestinal, the latter being the most common. 

The incidence of adenocarcinoma of the esophagus is 30-40 fold higher in patients with Barrett's esophagus than in the general population. Furthermore, the incidence of carcinoma rises with the degree of dysplasia, and Barrett's with severe dysplasia can be equated to carcinoma in-situ. 

Barrett's esophagus is indicative of gastroesophageal reflux. Its presence indicates that antireflux measures should be taken and because of the increased incidence of tumor development surveillance endoscopies should be instituted. The metaplastic epithelium generally does not resolve with either medical or surgical management of the associated reflux. Barrett's esophagus with high-grade dysplasia is an indication for esophagectomy