Image Based Question – 70048

A patient presented with suffering from long standing acid reflux.Esophageal biopsy shows the following features.Which is the gold standard test to diagnose this condition?

A. Endoscopic Biopsy

B. Screening Endoscopy

C. Chromoendoscopy

D. CT scan

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Correct Answer » A Explanation

Ans:A. Endoscopic Biopsy.

The patient is suffering from Barrett’s Esophagus.

Image shows:Barrett’s oesophagus. Part of the oesophagus which is normally lined by squamous epithelium undergoes metaplastic change to columnar epithelium of intestinal type.

Barrett’s Oesophagus

• This is a condition in which, following reflux oesophagitis, stratified squamous epithelium of the lower oesophagus is replaced by columnar epithelium (columnar metaplasia).

• Barrett’s oesophagus is a premalignant condition evolving sequentially from Barrett’s epithelium (columnar metaplasia) → dysplasia → carcinoma in situ →oesophageal adenocarcinoma.

MORPHOLOGIC FEATURES.

• Endoscopically, the affected area is red and velvety.

• Hiatus hernia and peptic ulcer at squamocolumnar junction (Barrett’s ulcer) are frequently associated.

• Microscopically, the most common finding is the replacement of squamous epithelium by metaplastic columnar cells.

• Barrett’s oesophagus may be composed of intestinal epithelium, fundic gastric glands, or cardiac mucous glands.

• Other cells present in the glands may be Paneth cells , goblet cells, chief cells, parietal cells, mucus-secreting cells and endocrine cells.

• Endoscopic biopsy is the gold standard for confirmation of Barrett’s esophagus.