Surveillance for Barrett's oesophagus

doi:10.1136/bmj.322.7294.1124

BMJ 2001;322:1124 ( 5 May )

Letters

Surveillance for Barrett's oesophagus

The conundrum of Barrett's oesophagus is changing

It is too early to dismiss surveillance programmes

Patients need to be appropriately selected for follow up

Appropriate practice must be studied

Authors' response

The conundrum of Barrett's oesophagus is changing

The first 150 words of the full text of this article appear below.

EDITOR $---$ Macdonald et al in their paper and McGarrity in his accompanying editorial reviewed the value of endoscopic surveillanceof Barrett's oesophagus. ¹ ² Both articles highlighted themajor problems with detection of oesophageal adenocarcinoma inan unselected group of individuals with Barrett'soesophagus.

Much attention has been devoted to risk stratification of individuals who are at high risk of malignant change in Barrett'soesophagus. Men over 45 years, those with at least 3 cm of Barrett'smetaplasia, those with severe and frequent reflux symptoms (>3times week), those with chronic heartburn for 10 years or more,obese patients, those taking drugs which relax the lower oesophagealsphincter (such as nitrates), and perhaps those with eradicatedHelicobacter pylori infection are most at risk of Barrett's associatedadenocarcinoma.³

Pathology has also made a major contribution to understanding the pathogenesis as intestinal type metaplasia gives rise todysplastic clones from which the adenocarcinoma arises.³ Moleculargenetics . . . [Full text of this article]

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Final results from 10 year cohort of patients undergoing surveillance for Barrett's oesophagus: observational study: Christopher E Macdonald, Anthony C Wicks, and Raymond J Playford
BMJ 2000 321: 1252-1255. [Abstract] [Full Text] [PDF]