Barrett's oesophagus is a change in the normal squamous epithelium of the oesophagus to specialised intestinal metaplasia.
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. This is associated with gastro-oesophageal reflux, even if the reflux is asymptomatic. Essential to the diagnosis is histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells. Beyond gastro-oesophageal reflux-related symptoms, the main concern is the increased risk of adenocarcinoma of the oesophagus.
History and exam
Key diagnostic factors
- presence of risk factors
Other diagnostic factors
- incidental finding during gastrointestinal endoscopy for other indication
- chest pain
- dyspnoea or wheezing
- history of aspiration pneumonia
- acid/bile reflux or GORD
- increased age
- white ethnicity
- male sex
- family history of Barrett's oesophagus or oesophageal adenocarcinoma
1st investigations to order
- upper GI endoscopy with biopsy
- barium oesophagogram
- autofluorescence imaging
- confocal laser endomicroscopy
- optical coherence tomography
- transnasal endoscopy
- capsule endoscopy
- gelatin-coated sponge
non-dysplastic Barrett's oesophagus
- Oesophageal adenocarcinoma
- Guideline on informed consent for GI endoscopic procedures
- Adverse events associated with EGD and EGD-related techniques
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