Which histologic feature is characteristic of Barrett esophagus?

Which histologic feature is characteristic of Barrett esophagus?

• A. Basal cell hyperplasia
• B. Elongation of lamina propria papillae
• C. Squamous epithelium with basal hyperplasia
• D. Goblet cells within columnar epithelium replacing squamous mucosa

Answer: (D)

Barrett esophagus is defined by intestinal metaplasia in the distal esophagus, where the normal squamous lining is replaced by columnar epithelium that includes goblet cells. Goblet cells are mucus-producing cells typical of intestinal-type mucosa, not native esophageal tissue, so their presence within the esophageal mucosa signals a metaplastic change from squamous to intestinal-type lining. This goblet cell–containing columnar epithelium replacing squamous mucosa is the hallmark histologic feature of Barrett esophagus. Other findings like basal cell hyperplasia or elongation of the lamina propria papillae can occur with reflux esophagitis but do not define Barrett; they reflect inflammatory changes rather than the metaplastic transformation to intestinal-type mucosa.

Barrett esophagus is defined by intestinal metaplasia in the distal esophagus, where the normal squamous lining is replaced by columnar epithelium that includes goblet cells. Goblet cells are mucus-producing cells typical of intestinal-type mucosa, not native esophageal tissue, so their presence within the esophageal mucosa signals a metaplastic change from squamous to intestinal-type lining. This goblet cell–containing columnar epithelium replacing squamous mucosa is the hallmark histologic feature of Barrett esophagus.

Other findings like basal cell hyperplasia or elongation of the lamina propria papillae can occur with reflux esophagitis but do not define Barrett; they reflect inflammatory changes rather than the metaplastic transformation to intestinal-type mucosa.