Barrett's Esophagus — Diagnosis, Surveillance & Endoscopic Eradication Therapy

A comprehensive guide from screening to EET, incorporating ACG guidelines and AGA clinical decision support tools.

GuidelinesACG BE Guidelines (2022) · AGA Spotlight (2024)Content reviewedMarch 2026

6 Core Sections6 Quiz QuestionsAGA Spotlight 2024 · ACG BE Guidelines

Barrett's Esophagus

Definition, risk factors & pathogenesis

What is Barrett's Esophagus?

Barrett's esophagus (BE) is the replacement of normal squamous epithelium of the distal esophagus with specialized intestinal metaplasia (IM) — a salmon-colored mucosa extending proximally from the gastroesophageal junction (GEJ). It is a premalignant condition and the only known precursor to esophageal adenocarcinoma (EAC).

Risk Factors

Chronic GERD (most important)

Obesity / central adiposity

Male sex

Age >50

White race

Smoking

Family history of BE or EAC

Hiatal hernia

Protective Factors

H. pylori infection (paradoxically protective)

Regular aspirin / NSAID use

Mediterranean diet

Regular physical activity

Female sex

Non-smoking

Progression Spectrum

NDBE→IND→LGD→HGD→EAC

NDBE: Non-dysplastic BE

IND: Indefinite for dysplasia

LGD: Low-grade dysplasia

HGD: High-grade dysplasia

Annual Risk of EAC Progression

NDBE: ~0.1–0.3%/year | LGD: ~0.5%/year | HGD: ~6–7%/year. Most patients with BE never develop cancer — but surveillance and EET for high-risk lesions can prevent progression.

Prague Classification (C&M Criteria)

Standardized reporting of BE extent:

C (Circumferential):Length of circumferential BE above GEJ in cm

M (Maximum):Maximum extent of BE above GEJ including tongues

Example: C2M5 = 2 cm circumferential, 5 cm maximum extent