Clinical Review

Diagnosis and management of Barrett’s oesophagus

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4551 (Published 10 September 2010) Cite this as: BMJ 2010;341:c4551
  1. Janusz Jankowski, James Black fellow1, James Black professor2, consultant gastroenterologist3,
  2. Hugh Barr, professor4, oesophagogastric resection surgeon5,
  3. Ken Wang, professor of gastroenterology6,
  4. Brendan Delaney, Guy’s and St Thomas’ charity chair of primary care research7
  1. 1Gastrointestinal Oncology Group, University of Oxford, Oxford
  2. 2Centre for Digestive Disease, Blizard Institute, Queen Mary University of London, London
  3. 3Digestive Disease Centre, University Hospitals of Leicester, Leicester
  4. 4Cranfield Health, Cranfield University, Cranfield, Bedfordshire
  5. 5Department of Surgery, Gloucestershire Royal Hospital, Gloucestershire
  6. 6Advanced Endoscopy Group and Esophageal Neoplasia, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Department of Primary Care and Public Health Sciences, King’s College London, London
  1. Correspondence to: J Jankowski j.a.jankowski{at}qmul.ac.uk

    Summary points

    • Barrett’s oesophagus usually occurs as a consequence of chronic gastro-oesophageal reflux disease

    • The incidence of Barrett’s oesophagus is increasing: the condition is present in 2% of the adult population in the West

    • The incidence of oesophageal adenocarcinoma related to Barrett’s oesophagus is also increasing. In the United Kingdom, especially Scotland, oesophageal adenocarcinoma rates are higher than anywhere else in the world

    • Patients detected with early cancer related to Barrett’s oesophagus might have surgically or endoscopically curable disease. Endoscopic therapy is recommended as an alternative to oesophagectomy for patients with dysplasia

    • The value of protocol based endoscopic surveillance to detect early cancer is yet to be established and is the subject of a major randomised clinical trial.

    • Other cancer prevention strategies being tested are chemoprevention of Barrett’s oesophagus by aspirin in the 2513 patient AspECT trial and genome-wide identification of inherited risk factors in the 4500 patient EAGLE consortium study

    Barrett’s oesophagus affects 2% of the adult population in the West, which makes it one of the most common premalignant lesions after colorectal polyps. Conversion to oesophageal adenocarcinoma is the most important complication of the condition, with a lifetime risk of 5% in men and 3% in women.1 2 3 4 Several large trials investigating surveillance (Barrett’s Oesophagus Surveillance Study (BOSS)), chemoprevention (the Aspirin Esomeprazole Chemoprevention Trial (AspECT)), genetic stratification (EArly Genetics and Lifecourse Epidemiology (EAGLE) consortium), and endotherapy for high risk individuals are under way to determine the best way to prevent progression to adenocarcinoma.

    There are now several endoscopic alternatives to the long established technique of radical surgical oesophagectomy for treating high grade dysplasia and early mucosal cancer, which avoid the mortality and morbidity of surgery. Recently consensus on optimal management of the condition was reached after a National Institute of Health and Clinical Excellence (NICE) review. It …

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