What potential sequela is common in untreated Barrett's esophagus?

Barrett's esophagus is a condition that arises as a complication of chronic gastroesophageal reflux disease (GERD), where the normal squamous cell lining of the esophagus is replaced with a columnar lining due to chronic injury from acid exposure. This process is known as intestinal metaplasia.

The most significant potential sequela of untreated Barrett's esophagus is the development of adenocarcinoma, a type of esophageal cancer. The metaplastic transformation in Barrett's esophagus creates a higher risk for malignant transformation. Over time, patients with Barrett's esophagus can progress through dysplastic changes—where cells exhibit abnormal growth—before developing into cancer. Therefore, surveillance and potential treatment strategies are crucial for patients diagnosed with Barrett's esophagus in order to detect dysplasia or cancer early.

In contrast, while esophageal strictures, perforation, and persistent acid reflux may occur in other esophageal conditions or as complications of severe GERD, they are not direct sequelae of Barrett's esophagus itself. The primary concern remains the risk of malignancy, making the association with adenocarcinoma the most critical outcome to monitor in patients with Barrett's esophagus.