Not Barrett's Diagnosis?

My pathology report states: "The specimen is received in formalin labled "GE Junction" and consists of four fragments of tan soft tissue ranging from 0.2 to 0.5cm in greatest dimension.The specimen is submitted in its entirety in one cassette. Sections reveal fragments of squamocolumnar junction.In some areas, the GLANDULAR mucosa shows intestinal metaplasia that shows mild underlying chronic inflammation and mild reactive change. No dysplasia or carcinoma are identified. The SQUAMOUS mucosa shows areas of accentuation of the basal zone of the epithelium and intraepithelial easinophils consistent with a mild reflux esophagitis."

Please note that I capitalized the words "gladular" and "squamous" above to highlight my concern. The doctor who did my EGD is a general surgeon (not a gastroenterologist). After receiving his diagnosis of Barrett's Esophagus, I began researching the disease and found that the location of the biopsies is very important. I went back to ask and he specified that they were "At the junction." I told him why I was asking and he replied "You have Barrett's and you need to be on medication."

First of all, based on the doctor putting the four specimens in one cassette with the location only as "GE Junction", could the pathologist determine exactly where the biopsies were from and whether they represent Barrett's Esophagus?

Secondly, information on the barrettsinfo.com website states that a normal esophagus is lined by squamous cells. Is the pathologist, in her report, stating that the cells (squamous) from the esophagus tissue indicate mild reflux esophagitis while that glandular tissue has intestinal metaplasia?

The aforementioned website goes on to further state that "Intestinal metaplasia of the gastric cardia is very common in the general population...." and that the biopsy location is very important because "..ONLY specialized intestinalized metaplasia of the esophagus be referred to as Barrett's esophagus and warrants endoscopic cancer surveillance."

My questions to you are: (1) What is your interpretation of the patholgy report - i.e. Barrett's or something else. (2) Should a better location description have been given by the surgeon to the pathologist. (3) Do you feel that I should have another EGD by an experienced gastroenterologist before the recommended one year time frame has passed? Thank you for your help.

[Kevin Pho, MD]

There is some controversy in determine where the exact GE junction is - since there are no diagnostic landmarks to define the exact segment.  This sometimes makes it difficult to say whether definitively Barrett's esophagus is present or not.  

However, the presence of intestinal metaplasia suggests that Barrett's may be present.  Chronic gastric reflux can also cause this condition.

To answer your questions:
1) The findings can be suggestive of Barrett's esophagus or chronic reflux.
2) The exact GE junction can sometimes be difficult to discern - different physicians will have different interpretations of where it is.
3) If there is controversy about the findings, you can have the test repeated or discuss it with another opinion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[renee1952]

I'm not a Dr. but I can tell you the best way to get an accurate Barrett's diagnosis is to have your slides sent or to actually go to some place like John Hopkins. There are so many Barrett's diagnosis that have been reversed at one of the top rated hospitals that it seems unbelievable. JH has a Barrett's esophagus website and support board and if you visit there you will find many patients who were treated and diagnosed with Barrett's only to be seen or have their slides read at JH and found out they in fact did not have Barrett's. A key word I have noticed in these reports seem to be "Goblet Cells" ..If you don't have goblet cells then JH says NO BARRETT'S. The other problems are like you say, biopsies not taken in the right area.