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Barrett Esophagus Workup

  • Author: Mark H Johnston, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
Updated: Jun 22, 2016

Approach Considerations

The association of chronic GERD with Barrett esophagus and the inherent risk of progression from Barrett esophagus to adenocarcinoma of the esophagus have been established. Consequently, any patient aged 50 years or older, male or female, with a history of chronic GERD should have at least a 1-time upper endoscopy to screen for Barrett esophagus.


Esophagogastroduodenoscopy (EGD) is the procedure of choice for the diagnosis of Barrett esophagus. The diagnosis requires biopsy confirmation of SIM in the esophagus. An upper gastrointestinal series (UGI) or barium swallow cannot reliably establish the diagnosis of Barrett esophagus.

In cases of erosive esophagitis, a healing of the mucosa is required prior to EGD to ensure a lack of Barrett mucosa underneath the inflammation.

Histologic findings

The presence of SIM in the esophagus is required for the diagnosis of Barrett esophagus.


When high-grade dysplasia or cancer is found on surveillance endoscopy, endoscopic ultrasonography (EUS) is advisable to evaluate for surgical resectability.

Fluorescence in situ hybridization

A commercial four-color fluorescence in-situ hybridization (FISH) probe set to 9p12 (CDKN2A), 17q11.2-12 (HER2), 8q24.12-13 (CMYC), and 20q13.2 (ZNF217) appears to be able to detect aneusomy in Barrett esophagus.[12] In a study consisting of 20 cases of Barrett esophagus, significant increases inHER2, CMYC, and ZNF217 copy number were found in dysplastic mucosa compared with nondysplastic mucosa. However, non-detection of aneusomy did not rule out dysplasia.[12]

Contributor Information and Disclosures

Mark H Johnston, MD Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Lancaster Gastroenterology, Inc

Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.


John A Eastone, MD 

John A Eastone, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Marco G Patti, MD Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.


John A Eastone, MD Gastroenterology Fellow, Bethesda and Walter Reed Army Medical Center; Instructor, Department of Internal Medicine, F Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences

John A Eastone, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Ronnie Fass, MD Chief of Gastroenterology, Southern Arizona VA Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association

Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting research; Eisai Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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Barrett esophagus (BE). The salmon-pink area has specialized intestinal metaplasia. The white area is squamous epithelium.
Cryoablation of esophageal lining in Barrett esophagus (BE). This is one of the newest experimental ablative therapies for the esophagus performed at the author's laboratory.
Blistering of the esophageal mucosal layer after cryoablation in Barrett esophagus (BE).
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