A 52-year-old male with long-standing gastroesophageal reflux disease (GERD) undergoes surveillance endoscopy. Biopsies of the distal esophagus demonstrate replacement of normal stratified squamous epithelium by columnar epithelium with goblet cells (intestinal metaplasia). What is the diagnosis and its major clinical implication?

Answer and explanation

Correct answer: D. Barrett's esophagus; increased risk for esophageal adenocarcinoma

  1. Step 1: Identify histological finding: Specialized columnar epithelium with goblet cells (intestinal metaplasia) in the tubular esophagus defines Barrett's esophagus.
  2. Step 2: Recognize neoplastic risk: Barrett's esophagus is a premalignant condition that predisposes to the development of esophageal adenocarcinoma.
  3. Step 3: Determine management: Requires regular endoscopic surveillance with biopsies to detect low-grade or high-grade dysplasia early.
Answer
Barrett's esophagus; increased risk for esophageal adenocarcinoma.
Why not the others: 'Squamous cell carcinoma' arises from native squamous epithelium and is linked to smoking and alcohol, not GERD metaplasia; 'Achalasia' is an esophageal motility disorder caused by loss of myenteric plexus ganglion cells; 'Eosinophilic esophagitis' shows eosinophilic mucosal infiltration.

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