Barrett's oesophagus is known to be a premalignant condition in patients with gastroesophageal reflux disease, and most adenocarcinomas of the distal oesophagus have been shown to arise in Barrett's tissue. Barrett's oesophagus is defined histologically by the presence of specialised columnar epithelium (SCE) with goblet cells. The columnar-lined lower oesophagus can be identified during standard upper endoscopy. SCE is often present in a patchy mosaic contribution within columnar-lined lower oesophagus and can be overlooked by random biopsies, resulting in biopsies of the cardia or gastric type of mucosa without goblet cells. However, it has been suggested that four-quadrant step biopsies within the columnar-lined lower oesophagus should serve as the gold standard for diagnosing Barrett's epithelium and Barrett's-associated neoplastic changes.
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