TY - JOUR
T1 - Pathogenesis and Cells of Origin of Barrett's Esophagus
AU - Que, Jianwen
AU - Garman, Katherine S.
AU - Souza, Rhonda F.
AU - Spechler, Stuart Jon
N1 - Funding Information:
Funding This work was supported by the National Institutes of Health (DK113144, DK100342, DK120650 to J.Q.; DK098528, DK118022 to K.S.G.; DK63621, DK103598, K11139 to R.F.S. and S.J.S.) and by Baylor Scott & White Research Institute (R.F.S. and S.J.S.). Funding This work was supported by the National Institutes of Health ( DK113144, DK100342, DK120650 to J.Q.; DK098528, DK118022 to K.S.G.; DK63621, DK103598, K11139 to R.F.S. and S.J.S.) and by Baylor Scott & White Research Institute (R.F.S. and S.J.S.). All authors contributed equally to the preparation of this manuscript. Funding This work was supported by the National Institutes of Health ( DK113144, DK100342, DK120650 to J.Q.; DK098528, DK118022 to K.S.G.; DK63621, DK103598, K11139 to R.F.S. and S.J.S.) and by Baylor Scott & White Research Institute (R.F.S. and S.J.S.).
Publisher Copyright:
© 2019 AGA Institute
PY - 2019/8
Y1 - 2019/8
N2 - In patients with Barrett's esophagus (BE), metaplastic columnar mucosa containing epithelial cells with gastric and intestinal features replaces esophageal squamous mucosa damaged by gastroesophageal reflux disease. This condition is estimated to affect 5.6% of adults in the United States, and is a major risk factor for esophageal adenocarcinoma. Despite the prevalence and importance of BE, its pathogenesis is incompletely understood and there are disagreements over the cells of origin. We review mechanisms of BE pathogenesis, including transdifferentiation and transcommitment, and discuss potential cells of origin, including basal cells of the squamous epithelium, cells of esophageal submucosal glands and their ducts, cells of the proximal stomach, and specialized populations of cells at the esophagogastric junction (residual embryonic cells and transitional basal cells). We discuss the concept of metaplasia as a wound-healing response, and how cardiac mucosa might be the precursor of the intestinal metaplasia of BE. Finally, we discuss shortcomings in current diagnostic criteria for BE that have important clinical implications.
AB - In patients with Barrett's esophagus (BE), metaplastic columnar mucosa containing epithelial cells with gastric and intestinal features replaces esophageal squamous mucosa damaged by gastroesophageal reflux disease. This condition is estimated to affect 5.6% of adults in the United States, and is a major risk factor for esophageal adenocarcinoma. Despite the prevalence and importance of BE, its pathogenesis is incompletely understood and there are disagreements over the cells of origin. We review mechanisms of BE pathogenesis, including transdifferentiation and transcommitment, and discuss potential cells of origin, including basal cells of the squamous epithelium, cells of esophageal submucosal glands and their ducts, cells of the proximal stomach, and specialized populations of cells at the esophagogastric junction (residual embryonic cells and transitional basal cells). We discuss the concept of metaplasia as a wound-healing response, and how cardiac mucosa might be the precursor of the intestinal metaplasia of BE. Finally, we discuss shortcomings in current diagnostic criteria for BE that have important clinical implications.
KW - Esophageal Adenocarcinoma
KW - Esophagogastric Junction
KW - Gastroesophageal Reflux Disease
KW - Metaplasia
KW - Progenitor Cells
UR - http://www.scopus.com/inward/record.url?scp=85069576783&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069576783&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2019.03.072
DO - 10.1053/j.gastro.2019.03.072
M3 - Review article
C2 - 31082367
AN - SCOPUS:85069576783
SN - 0016-5085
VL - 157
SP - 349-364.e1
JO - Gastroenterology
JF - Gastroenterology
IS - 2
ER -