Overview
Definition
A metaplastic alteration of the esophageal mucosa where the normal stratified squamous epithelium is replaced by simple columnar epithelium with goblet cells (intestinal metaplasia), in response to chronic acid reflux.
Epidemiology
Found in ~10-15% of patients with chronic GERD. More common in white males over 50.
Etiology & Risk Factors
- Chronic acid and bile exposure from gastroesophageal reflux disease (GERD)
Clinical Symptoms
- Heartburn and acid regurgitation (symptoms of GERD)
- Dysphagia (if stricture develops)
- Can be asymptomatic
Clinical Approach
Diagnosis
- Upper endoscopy showing pink, salmon-colored mucosa extending above the gastroesophageal junction
- Histological confirmation of intestinal metaplasia with goblet cells
Management
- Aggressive acid suppression with high-dose PPIs
- Endoscopic surveillance (frequency depends on presence of dysplasia)
- Endoscopic mucosal resection or radiofrequency ablation for high-grade dysplasia
Complications
- Esophageal adenocarcinoma (30-40 fold increased risk)
- Esophageal strictures