The columnar-lined esophagus (Barrett syndrome)--an acquired condition?

Summary Columnar epithelium lining the lower esophagus in association with esophageal ulcer, esophageal stricture, and hiatal hernia is a distinct syndrome described originally by Barrett. Although generally considered to be of congenital origin, the columnar mucosa has been thought by some authors to represent an acquired change resulting from injury to the normal squamous lining. Pathological documentation of this latter concept, however, has been scanty. The patient described in this article displayed typical features of the Barrett syndrome. Of particular interest was the demonstration over a 30-month span of glandular epithelium at levels that had been occupied previously by squamous mucosa. This sequence of events appeared to result from recurrent gastroesophageal reflux, esophagitis, and regeneration of the destroyed esophageal lining by columnar rather than squamous epithelium. Support for the Barrett syndrome as an acquired condition, therefore, is strengthened.