What histologic finding is typically observed in Barrett's esophagus?

• A. Intestinal metaplasia
• B. Eosinophilic infiltration
• C. Basal cell hyperplasia
• D. Ulceration

Answer: (A)

Barrett's esophagus is defined by a metaplastic change in the lining of the distal esophagus: the normal squamous epithelium is replaced by nonciliated columnar epithelium containing goblet cells, i.e., intestinal metaplasia. This goblet-cell–containing, intestinal-type epithelium is the histologic hallmark that confirms Barrett’s and reflects chronic acid exposure from reflux. It’s important because Barrett’s carries an increased risk of progression to esophageal adenocarcinoma, which is why biopsy specimens are examined for this specific change. Eosinophilic infiltration points to eosinophilic esophagitis, basal cell hyperplasia is a nonspecific reflux change, and ulceration indicates mucosal injury rather than the characteristic metaplastic transformation seen in Barrett’s.