Clinical Review

Barrett’s oesophagus: diagnosis and management

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2373 (Published 11 May 2016) Cite this as: BMJ 2016;353:i2373
  1. Prachi Pophali, research fellow1,
  2. Magnus Halland, gastroenterologist1
  1. 1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN 55905, USA
  1. Correspondence to: M Halland halland.magnus{at}mayo.edu

What you need to know

  • Barrett’s oesophagus is the asymptomatic replacement of normal squamous epithelium of oesophagus by metaplastic columnar epithelium

  • It is a precursor for oesophageal adenocarcinoma

  • Gastro-oesophageal reflux disease (GORD) is strongest risk factor known and should be managed by optimising lifestyle factors and proton pump inhibitor therapy

  • For non-dysplastic Barrett’s oesophagus with intestinal metaplasia or any Barrett’s oesophagus >3 cm in length, treat GORD symptoms and perform endoscopic surveillance every 3-5 years

  • If dysplasia or neoplasia is confirmed on endoscopy, treatment options include endoscopic mucosal resection or radiofrequency ablation

Barrett’s oesophagus is a premalignant condition where the oesophageal squamous epithelium undergoes columnar change with metaplasia which predisposes to the development of oesophageal adenocarcinoma. In order for Barrett’s oesophagus to be diagnosed, a segment of the lower oesophagus has to be replaced by columnar tissue (fig 1). In patients with oesophageal columnar tissue without intestinal metaplasia the cancer risk is thought to be low. Many patients with Barrett’s oesophagus have no symptoms. Development of oesophageal adenocarcinoma is understood to progress in a stepwise manner following the sequence of oesophagitis, metaplasia, dysplasia, and finally adenocarcinoma (fig 2). This review describes how Barrett’s oesophagus is diagnosed and explores questions regarding current and future management strategies for Barrett’s oesophagus.

Fig 1 Endoscopic view and diagram of Barrett’s oesophagus

Fig 2 Diagram of progression of Barrett’s oesophagus from normal oesophageal epithelium to oesophageal adenocarcinoma

Methods

We searched PubMed, Medline, and the Cochrane database from inception to November 2015 using the primary search terms “Barrett’s oesophagus,” “Barrett’s management,” and “endoscopic therapy for Barrett’s.” Abstracts published in English were included. Priority was given to randomised controlled trials and meta-analyses; citations from case series and retrospective studies were included where appropriate.

How many people have Barrett’s oesophagus?

The prevalence of Barrett’s oesophagus ranges varies widely in the general population depending on the definition of diagnosis and …

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