Barrett-Ösophagus: Häufigkeit und Stellenwert einer neuen histopathologischen Klassifikation für die Diagnose

BACKGROUND: Barrett's esophagus is caused by gastroesophageal reflux and may progress towards esophageal adenocarcinoma. Currently diagnosis is established upon a mixture of endoscopic and histopathologic criteria. Recently a novel histopathology classification questions current policies regarding diagnosis of Barrett's esophagus. METHODS: Review on published frequency of Barrett's esophagus and critical analysis of the novel histopathology classification of columnar lined esophagus. RESULTS: Our review, including 40 studies and 95,386 persons (mean age 53 years) undergoing endoscopy and biopsy sampling from the esophagogastric junction revealed Barrett's esophagus (BE) in 1.6-2.0% of controls and 0.8-36% of individuals with dyspepsia and GERD symptoms and was similar for those with and without endoscopic visible columnar lined esophagus. BE seems to be predominant in males and BE-frequency increases with length of visible columnar lined esophagus and age. The novel histopathology classification (Paull-Chandrasoma classification) of columnar lined esophagus indicates that currently used endoscopic "model anatomy" is based on invalid criteria and should be given up. The endoscopic proximal stomach (cardia) is identified as "dilated end stage esophagus", which may give rise for intestinal metaplasia, dysplasia and adenocarcinoma. Critical analysis of a population-based study indicates that the frequency of BE is largely underestimated owing to misclassification of endoscopic and histopathologic findings. CONCLUSIONS: The frequency of Barrett's esophagus seems to be higher than estimated, shows a large variation and may be also present in asymptomatic controls. Uniform endoscopy, biopsy sampling and histopathology should be included for future Barrettmanagement.