title: Prospective evaluation of multilayered epithelium in Barrett's esophagus.
abstract: OBJECTIVE
  We recently identified a distinctive type of multilayered epithelium in two patients with Barrett's esophagus, which shows morphological characteristics of both squamous and columnar epithelium. This study was performed to prospectively evaluate the prevalence of multilayered epithelium in patients with Barrett's esophagus.
  
  
  METHODS
  Mucosal biopsies were obtained from the squamocolumnar junction (Z-line) of 58 patients with endoscopic evidence of esophageal columnar epithelium and from the gastroesophageal junction in 21 patients without endoscopic evidence of esophageal columnar epithelium. Specimens were evaluated for the presence of multilayered epithelium and goblet cells.
  
  
  RESULTS
  Twenty-four of 58 (41%) of the patients with endoscopic evidence of esophageal columnar epithelium had multilayered epithelium compared with only one of 21 patients (5%) in the control group (p = 0.005). Of the 58 patients in the study group, 43 had goblet cell metaplasia and 15 did not (p < 0.001). Only patients with goblet cell metaplasia had multilayered epithelium. Shorter lengths of columnar epithelium were noted in the 24 patients with goblet cells and multilayered epithelium compared with the 19 patients with goblet cells and no multilayered epithelium (p < 0.05).
  
  
  CONCLUSIONS
  Multilayered epithelium is strongly associated with goblet cell metaplasia in patients with endoscopic evidence of esophageal columnar epithelium. These data support the hypothesis that multilayered epithelium may represent a transitional stage in the development of Barrett's esophagus.
authors.affiliation: Department of Medicine and Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Shields
authors.forename: S J
authors.initials: SJ
authors.lastname: Rosenberg
authors.forename: F R
authors.initials: FR
authors.lastname: Zwas
authors.forename: B J
authors.initials: BJ
authors.lastname: Ransil
authors.forename: A J
authors.initials: AJ
authors.lastname: Lembo
authors.forename: R
authors.initials: R
authors.lastname: Odze
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000503:physiopathology*; D001706:Biopsy; D004848:Epithelium / Q000473:pathology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D020397:Goblet Cells / Q000473:pathology; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values