Barrett’s esophagus is a complication of gastroesophageal reflux disease. Which of the following statement(s) is/are true concerning this condition?

a.The histologic hallmark is the presence of “specialized” columnar epithelium regardless of how far it extends into the esophagus

c.High grade dysplasia will frequently be associated with foci of invasive carcinoma

d.Patients with adenocarcinoma arising in Barrett’s esophagus have a high incidence of p53 gene mutations

Barrett’s esophagus is now recognized as a complication of advanced gastroesophageal reflux disease. The histologic hallmark of Barrett’s esophagus is the presence of “specialized” columnar epithelium, which shows features of intestinal metaplasia, easily recognized by the presence of goblet cells. The presence of specialized epithelium is now regarded as the pathonomonic feature of Barrett’s esophagus regardless of how high it extends into the esophagus. Barrett’s esophagus may exist on its own, or may be itself associated with ulceration, stricture, and malignant change. Once Barrett’s epithelium is present, medical therapy or anti-reflux surgery rarely causes it to regress. Unless it is actually ablated, for example with laser therapy, it persists. The most significant feature of Barrett’s esophagus is its malignant potential. The metaplastic epithelium usually undergoes dysplastic change prior to becoming frankly neoplastic. High grade dysplagia is synonymous with carcinoma in situ, and if the esophagus is removed for such a condition, up to 50% will demonstrate foci of invasive carcinoma

In the past, the pathophysiology of Barrett’s esophagus was associated with alkaline reflux on esophageal pH monitoring. However, more recently using a bile sensor for monitoring bilirubin, this condition is frequently associated with excessive bile in the esophagus. Repetitive injury from noxious gastric juice can lead during the repair process to mutations in the p53 gene. Patients with adenocarcinoma arising in Barrett’s esophagus have a high incidence of p53 mutations.