Barrett’s esophagus: its pathology and neoplastic complications

Barrett’s esophagus remains the most enigmatic of conditions. In Western communities, it has increased dramatically and its malignant complication, adenocarcinoma, is stated to be the cancer increasing the most in the Western world. Although this Western epidemic can be partly attributed to increasing reflux disease, there remain major controversies with regard to the pathogenesis, histogenesis, and even definitions of the disease. For pathologists, there are particular controversies as to the importance of the demonstration of “specialized” intestinal metaplasia and there have been many attempts to demonstrate a specific (and thus specialized) phenotype, compared with, say, intestinalization in the stomach. There has been much recent work on cytokeratin subsets and this shows some promise for differentiating the different types of intestinal metaplasia in this area.