Barrett's oesophagus

Barrett's oesophagus is a condition in which there is gastric or intestinal metaplasia of the mucosa of the distal oesophagus.

• most often an acquired condition although it may rarely be congenital in origin,
• long-standing gastro-oesophageal reflux results in replacement of esophageal squamous mucosa with metaplastic columnar mucosa that confers a predisposition to cancer
  • this process appears to cause the squamocolumnar junction (ora serrata) to migrate caudally
  • cancer risk is thought to be low in oesophageal columnar tissue lacking intestinal metaplasia (1,2)

Barrett's oesophagus can be classified according to the segment of metaplastic columnar epithelium that replaces the stratified squamous epithelium normally lining the distal oesophagus:

• long segment Barrett's oesophagus – if the segment is >3cm
• short segment Barrett's oesophagus - if the segment is <3cm

Characteristics associated with Barrett esophagus include (3):

• older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger),
• male sex,
• smoking (prevalence of approximately 12 % in people who smoke cigarettes compared with 1.1 % in those who do not smoke cigarettes)

Note:

• progression of Barrret's oesophags to adenocarcinoma is thought to develop in a stepwise manner; following the sequence of oesophagitis, metaplasia, dysplasia, and finally adenocarcinoma (1)
• approximately 4% to 5% of patients with Barrett esophagus will be diagnosed with oesophageal adenocarcinoma in their lifetime (3)
  • people with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing oesophageal adenocarcinoma
• evidence shows that there was a 30% reduction in mortality for people who received endoscopic surveillance compared to those that did not (4)

Reference:

• (1) Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ. 2016;353:i2373
• (2) Shaheen NJ et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016;111(1):30-50
• (3) Sharma P.Barrett Esophagus: A Review. JAMA. 2022;328(7):663-671. doi:10.1001/jama.2022.13298
• (4) NICE (February 2023). Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management