The severity of Barrett’s esophagus can be differentiated in 3 aspects: length of the metaplastic columnar epithelium, PragueCM staging, and histopathology.
1. Length of the pyogenic columnar epithelium: in short-segment barrett’s esophagus, the pyogenic columnar epithelium did not involve the whole esophagus or involved the whole esophagus but was 1-3 cm in length; in long-segment barrett’s esophagus, the pyogenic columnar epithelium involved the whole esophagus and was ≥3 cm in length.
2. PragueCM typing: “C” represents the length of peripheral metaplastic mucosa, and “M” represents the maximum length of non-peripheral metaplastic mucosa. For example, C2-M4 indicates that the length of peripheral columnar epithelial lesions is 2 cm, and the maximum length of non-peripheral columnar epithelial lesions is 4 cm. The smaller the extent of involvement, the lower the relative severity.
3. Histopathology: Barrett’s esophagus without heteroplasia, Barrett’s esophagus with indeterminate heteroplasia, low-grade heteroplasia, high-grade heteroplasia, and intramucosal carcinoma. The higher the degree of heteroplasia, the higher the cancer rate and the worse the prognosis.
The severity of barrett’s esophagus needs to be differentiated according to the length of columnar epithelial hyperplasia, the extent of involvement, and the degree of heterogeneity of the tissue, and cannot be determined from one aspect alone. barrett’s esophagus needs to be examined regularly, and early treatment is required for the discovery of lesions.