Intestinal metaplasia in a patient with chronic heartburn indicates Barrett’s esophagus, a complication of chronic gastroesophageal reflux disease (GERD).
In GERD, stomach acid converts normal esophageal non-keratinizing stratified squamous epithelium into columnar epithelium with interspersed goblet cells, which are not found in the normal esophagus. Patients are at increased risk for esophageal adenocarcinoma.
Shalauta et al. discuss the pathohistology of Barrett's esophagus. They report that over time, untreated reflux esophagitis may result in complications, including esophageal stricture or the development of Barrett's esophagus, a premalignant metaplastic process that usually involving the distal esophagus.
Yerian discusses GERD histology, in which the diagnosis of Barrett's dysplasia requires the presence of intestinal metaplasia in the esophagus, which can present several challenges including sampling error, observer variation, and difficulty in histologic interpretation.
Illustration A shows the histology of goblet cells.
Illustration B shows an endoscopic view of Barrett's esophagus.
Answer 1: Chief cells are present in the stomach and release pepsinogen and gastric lipase
Answer 2: Keratinized stratified squamous epithelium contains keratin, which protects against abrasion. Normal esophageal epithelium is non-keratinized squamous epithelium
Answer 3: Simple cuboidal epithelium is found in the ovaries and the walls of renal tubules
Answer 5: Polymorphonuclear leukocytes would indicate an inflammatory response. No such response is present in Barrett's esophagus
Shalauta MD, Saad R. Barrett's esophagus. Am Fam Physician. 2004 May 1;69(9):2113-8. Review
PMID:15152957 (Link to Abstract)
Yerian L. Histology of metaplasia and dysplasia in Barrett's esophagus. Surg
PMID:19500733 (Link to Abstract)
USMLE World Step 1 QBank Question #285. Copyright © USMLEWorld, LLC 2012