Key Points

• In the United States, the diagnosis of Barrett’s esophagus (BE) requires both histologic and endoscopic components, including intestinal metaplasia on histology and endoscopic evidence of glandular mucosa within the tubular esophagus.
• Dysplasia is the best available biomarker of Barrett’s neoplastic progression. Assessment of surface epithelial maturation is the single most important diagnostic criterion to distinguish reactive epithelial changes from Barrett’s neoplasia.
• Accurate pathologic diagnosis of the neoplastic spectrum in Barrett’s esophagus depends crucially on the pathologist’s exposure to a high-volume practice of Barrett’s esophagus.
• Therapy for BE-related dysplasia primarily depends on endoscopic appearance. Most visible lesions are managed by larger endoscopic resections, such as endoscopic mucosal resection. Radiofrequency ablation is the preferred modality for endoscopic eradication of intestinal metaplasia as well as dysplasia.
• An important clinical and histologic mimic of gastroesophageal reflux disease is eosinophilic esophagitis, which requires thorough clinical and endoscopic evaluation as well as documentation of lack of response to proton pump inhibitor therapy.