American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the characteristic finding in Barrett's diagnosis?

1. Columnar lined esophagus

2. Squamous cell carcinoma

3. Gastric ulcers

4. Esophageal diverticulum

The correct answer is: Columnar lined esophagus

The characteristic finding in Barrett's esophagus is the presence of a columnar lined esophagus. This occurs when the normal squamous epithelium of the esophagus is replaced by columnar epithelium, a process known as intestinal metaplasia. This change is often a response to chronic gastroesophageal reflux disease (GERD), where the acidic gastric contents repeatedly damage the lining of the esophagus. Barrett's esophagus is significant because it is a precancerous condition associated with an increased risk of developing esophageal adenocarcinoma. The identification of columnar epithelium in the distal esophagus through endoscopy and biopsy is key to diagnosing Barrett's esophagus and distinguishing it from other gastrointestinal conditions. In contrast, the other options do not represent the characteristic features of Barrett's esophagus. Squamous cell carcinoma is a type of cancer that can occur in the esophagus but is not a finding specific to Barrett’s. Gastric ulcers pertain to the stomach and are not directly related to the structural changes in the esophagus seen with Barrett's. Esophageal diverticulum is a different condition characterized by outpouching in the esophageal wall, again not indicative of Barrett's esophagus. Thus