Columnar-lined oesophagus (Barrett's syndrome) - congenital or acquired?

A segment of the distal oesophagus lined with columnar epithelium (endobrachy oesophagus, Barrett's oesophagus), is very frequently seen in association with chronic reflux conditions. Usually, this entity is an asymmetrical columnar-cell metaplasia of varying extent, with an unsharp epithelial junction line cranial, and showing various large residual islands of squamous epithelium. In addition, usually well-developed peptic lesions are also found. More rarely seen are cases with a longer, symmetrical, cranially sharply delimited columnar-epithelial-lined segment, in which peptic lesions and strictures are usually either restricted to the proximal section, or are lacking altogether. Among more than 100 patients presenting with endobrachy-oesophagus, 14 cases had the latter form of the condition. Seven had a solitary, high peptic stricture, and only 50% unequivocal hiatus hernia. In four patients there were no inflammatory changes at all. In 8 patients, fundic glands were observed. Of particular interest was the segment-like arrangement of cardiac and fundic glands in 2 of the patients. In only a single case were scar formations seen in the columnar-lined segment. Considered from the point of view of our embryological knowledge, certain forms of endobrachy-oesophagus would appear to represent a congenital anomaly.