Barrett's oesophagus

Barrett's oesophagus describes a change in the squamous epithelium of the oesophagus to intestinal-type epithelium with metaplasia on biopsy.

Presentation may be asymptomatic, but it typically occurs in middle-aged white men who have had chronic gastro-oesophageal reflux disease (GORD). Additional risk factors include tobacco use and obesity.

Cancer risk is determined by the degree of dysplasia.

Endoscopic screening and surveillance programmes have multiple shortcomings. Screening of the general population is not recommended, and surveillance intervals vary depending on histological findings.

Proton-pump inhibitors are commonly used to control GORD symptoms and may reduce the risk of neoplastic Barrett's oesophagus.

Endoscopic therapies play a central role in the management of dysplastic Barrett's oesophagus and early oesophageal adenocarcinoma.

Barrett's oesophagus is a change in the normal squamous epithelium of the oesophagus to specialised intestinal metaplasia. [1] Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63:7-42. http://gut.bmj.com/content/63/1/7.long http://www.ncbi.nlm.nih.gov/pubmed/24165758?tool=bestpractice.com This is associated with gastro-oesophageal reflux, even if the reflux is asymptomatic. [2] Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006;22:406-411. http://www.ncbi.nlm.nih.gov/pubmed/16760758?tool=bestpractice.com [3] Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005;128:1554-1566. http://www.ncbi.nlm.nih.gov/pubmed/15887151?tool=bestpractice.com Essential to the diagnosis is histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells. [4] Flejou JF, Svrcek M. Barrett's oesophagus: a pathologist's view. Histopathology. 2007;50:3-14. http://www.ncbi.nlm.nih.gov/pubmed/17204017?tool=bestpractice.com Beyond gastro-oesophageal reflux-related symptoms, the main concern is the increased risk of adenocarcinoma of the oesophagus. [2] Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006;22:406-411. http://www.ncbi.nlm.nih.gov/pubmed/16760758?tool=bestpractice.com [3] Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005;128:1554-1566. http://www.ncbi.nlm.nih.gov/pubmed/15887151?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Barrett's oesophagus; note salmon-coloured mucosa extending superior to the gastro-oesophageal junction as a continuous column From the personal collection of Dr Vic Velanovich; used with permission [Citation ends]. [Figure caption and citation for the preceding image starts]: Barrett's oesophagus; note salmon-coloured mucosa extending superior to the gastro-oesophageal junction with marked irregular border From the personal collection of Dr Vic Velanovich; used with permission [Citation ends]. [Figure caption and citation for the preceding image starts]: Barrett's metaplasia without dysplasia, demonstrating columnar epithelium with goblet cells from superior to the gastro-oesophageal junction Courtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. [Figure caption and citation for the preceding image starts]: Barrett's metaplasia with low-grade dysplasia; note the more irregular cells and nuclei Courtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. [Figure caption and citation for the preceding image starts]: Barrett's metaplasia with high-grade dysplasia; note more advanced irregularity of the cells Courtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends]. [Figure caption and citation for the preceding image starts]: Barrett's metaplasia with high-grade dysplasia associated with a focus of intramucosal carcinoma; note the frankly malignant cells beyond the confines of the basement membrane to involve the lamina propria Courtesy of Adrian Ormsby, MD, Henry Ford Hospital, Detroit, MI [Citation ends].