Barrettʹs oesophagus: diagnosis and management

Gastro-oesophageal reflux disease and its sequela, Barrettʹs oesophagus, are the major recognized risk factors for oesophageal adenocarcinoma, a tumour whose frequency has increased dramatically in Western countries over the past few decades. Barrettʹs oesophagus develops through the process of metaplasia in which one adult cell type replaces another. The metaplastic, intestinal-type cells of Barrettʹs oesophagus are predisposed to develop genetic changes that eventuate in cancer. This report reviews the recent controversy regarding diagnostic criteria for Barrettʹs oesophagus, and provides practical guidelines for identifying the condition. The risks and benefits of the proposed medical, surgical and endoscopic therapies for Barrettʹs oesophagus are discussed in detail, and the approach to management recently endorsed by the American College of Gastroenterology is summarized.