Unearthing the significance of buried intestinal metaplasia

Pre-cancerous Barrett's esophagus (BE) arises from columnar metaplasia of the squamous mucosa secondary to chronic reflux injury. If untreated, the metaplastic columnar epithelium may undergo a dysplastic transformation and in a subset of patients subsequently progresses to adenocarcinoma. New endoscopic modalities can successfully ablate the Barrett's mucosa to be replaced by neosquamous mucosa while the patients are taking a proton pump inhibitor. Although these advances have a positive impact on the conservation of the esophagus and treatment of early neoplasia, they have uncovered the issue of "buried BE" or "subsquamous intestinal metaplasia (SSIM)." SSIM is defined as the presence of esophageal subepithelial columnar epithelium underlying a restored squamous mucosal lining.

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