In Barrett's esophagus, what endoscopic finding is observed?

• A. Erythema and erosions
• B. Pyloric sphincter dilation
• C. Esophageal varices
• D. Red columnar mucosa with intestinal metaplasia

Answer: (D)

The endoscopic hallmark of Barrett's esophagus is the replacement of the normal squamous lining in the distal esophagus with intestinal-type columnar epithelium, seen as red, columnar (salmon-colored) mucosa that often extends upward from the gastroesophageal junction. This appearance reflects metaplasia due to chronic acid exposure, and it is the finding endoscopists look for to suspect Barrett's, with biopsy confirming intestinal metaplasia (goblet cells). Other findings like erythema and erosions point to generic reflux esophagitis, not Barrett's; dilation of the pyloric sphincter is a gastric outlet issue, and esophageal varices relate to portal hypertension—neither describes Barrett's.