Barrett's esophagus: The long and the short of it

Specialized intestinal epithelium occurs more frequently at the gastroesoph ageal junction than previously anticipated. It can occur either within tong ues of mucosa (short segment Barrett's) or just beneath a normal z-line (in testinal metaplasia at the gastroesophageal junction). Whether the etiopath ogenesis and the natural history of these two conditions are the same is as get unclear. The role of gastroesophageal reflux disease (GERD), Helicobac ter pylori, and inflammation at the gastroesophageal junction in the pathog enesis of short segment Barrett's and intestinal metaplasia at the gastroes ophageal junction needs to be carefully documented. Intestinal metaplasia a t the gastroesophageal junction, short segment Barrett's, and Barrett's may represent a continuum of the same disease process. Recent evidence suggest s, however, that short segment Barrett's shares similar characteristics wit h Barrett's but may be distinct from intestinal metaplasia at the gastroeso phageal junction. It is conceivable that short segment Barrett's may remain steady or even regress if and when the noxious influence wanes but, with c ontinuing stimulation, short segment Barrett's may lengthen further to beco me what we observe to be Barrett's, If correct, endogenous or exogenous fac tors that induce progression need to be identified. Acid and bile reflux an d H. pylori are possible candidates acting either singly or synergistically , Finally, the true neoplastic potential of short segment Barrett's needs c larification. (C) 1999 by Am. Cell. of Gastroenterology.