Symptoms and diagnosis of Barrett oesophagus

Barrett oesophagus is a premalignant condition in which metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the lower oesophagusWhiteman, 2015. It is thought to be caused by chronic oesophageal injury from gastro-oesophageal reflux in susceptible individuals. Barrett oesophagus may be associated with severe mucosal disease or strictures, but some patients have minimal or no symptoms or oesophagitis. Barrett oesophagus is most commonly diagnosed in overweight, middle-aged, Caucasian males. It is an endoscopic diagnosis (see Indications for upper gastrointestinal endoscopy in patients with symptoms suspected to be due to gastro-oesophageal reflux for the indications for upper gastrointestinal endoscopy).

Barrett oesophagus is associated with a significant relative risk of adenocarcinoma of the lower oesophagus, although the absolute risk is small (estimated to be 0.25% per year in surveillance programs, with an estimated lifetime risk of oesophageal carcinoma of 5%)Whiteman, 2015. The risk is greatest in Caucasian males older than 50 years who have central obesity and a long segment of Barrett oesophagus.

If Barrett oesophagus is diagnosed on endoscopy, refer to a gastroenterologist for a discussion with the patient about whether a surveillance program (with regular biopsies to detect dysplasia or early malignancy, and specialist follow-up) is appropriate for them.

Endoscopic surveillance is the standard of care and should be conducted according to current guidelines (eg the Cancer Council guidelines), as there is evidence of both over- and under-surveillance. Although analysis of surveillance programs has not demonstrated convincing benefit in reducing mortality, tumours detected by surveillance have a lower stage and better prognosis than tumours detected when they are symptomaticWhiteman, 2015.