Genesis of Barrett’s Neoplasia: Current Concepts

Barrett’esophagus is the replacement of the esophageal squamous epithelium with metaplastic columnar epithelium. This phenomenon, related to gastro-esophageal reflux, has increased in incidence over the last two decades, and with it there has been a similar increase in Barrett’s associated adenocarcinomas. In this chapter we describe the pathologic features of Barrett’s esophagus and of Barrett’s associated dysplasia and carcinoma. We address important aspects related to the clinical presentation, endoscopic findings, and differential diagnosis of Barrett’s esophagus. In addition, we present an overview of the molecular pathways involved in the genesis and progression of Barrett’s esophagus, and on the identification of potential molecular markers predictive of progression from normal esophageal mucosa to Barrett’s esophagus, to dysplasia, to carcinoma. Finally, we briefly review the use of recent technologies including cDNA microarray, micro-RNA, and proteomics to improve the diagnosis of Barrett’s associated dysplasia, and to identify gene or protein signatures predictive of progression in Barrett’s esophagus.