It is not an easy task to differentiate between Barrett’s esophagus and their mimickers especially in biopsies. Some subtle clues and special stains can help. Find these clues in the difference tables below.
| Feature | Barrett’s Esophagus | Gastric Metaplasia | Gastroesophageal Reflux Disease (GERD) | Other Mimickers |
|---|---|---|---|---|
| Goblet Cell Morphology | Present, distinctive | Absent or less prominent | Absent | Variable |
| Mucin Type | Acidic mucins (sialomucins) | Neutral to acidic mucins | Mostly neutral mucins | Depends on condition |
| Architectural Features | Columnar epithelium with goblet cells | Columnar epithelium without goblet cells | Squamous epithelium | Varies |
| Alcian blue | Stains blue | Negative | Negative | Variable |
| PAS Stain | Positive in goblet cells | Variable | Negative | Variable |
| PAS-AB Stain | Deep Blue staining in goblet cells | Magenta in foveolar cells | Negative | Variable |
| Immunohistochemistry | CDX2 positive, MUC2 positive | CDX2 negative, MUC2 negative | Not applicable | Condition specific |
| Other Key Features | Intestinal-type epithelium, dysplasia possible | Foveolar-type epithelium, no dysplasia | Inflammation, no intestinal metaplasia | Depends on condition |
Note: “Other Mimickers” can include various conditions that may resemble Barrett’s Esophagus histologically, such as intestinal metaplasia related to H. pylori gastritis, certain types of adenocarcinomas, or other rare conditions. These would need to be characterized individually based on the specific condition being considered.
Find Detailed discussion of Barret’s Esophagus mimics below:
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