Do Transcription Factors Hold the Key to Understanding the Development of Barrett’s Esophagus?

Excerpt

Barrett’s esophagus is a complex metaplasia which can occur as a pure gastric or intestinal histopathological phenotype but more commonly occurs as a mosaic comprising gastric and intestinal forms. Intestinal metaplasia is typified by the presence of goblet cells seen on light microscopy. Some studies indicate that the chances of identifying goblet cells are related to the length of Barrett’s, location of the biopsies (more goblet cells in proximal esophagus), number of biopsies, patient age and gender, being more common in men [1]. Most interest has focussed on those patients with an endoscopically visible columnar lined epithelium containing intestinal metaplasia since this is the form most clearly associated with malignancy with an annual progression rate estimated to be in the region of 0.3–0.4% per annum [2, 3]. However, recent studies comparing goblet and non-goblet containing metaplastic epithelium have shown that both types demonstrate the same frequency of DNA content abnormalities [4, 5], suggesting that the gastric form is not entirely benign. …