Barrett’s Oesophagus in 2016

Barrett’s oesophagus (BO) is one of the most important complications of gastro-oesophageal reflux disease as it may progress to oesophageal adenocarcinoma. There is currently a rising incidence of BO. The pathogenesis of BO is not well-understood although genetic and environmental factors play significant roles. BO can be dysplastic or non-dysplastic. In the case of dysplastic BO, two pathologists’ opinions are required. As patients with BO can be entirely asymptomatic, it is difficult to screen this population group. Currently, screening is recommended only for white males with certain risk factors according to American College of Gastroenterology (ACG) guidelines in the USA. The extent of BO can be reliably measured using the Prague classification. Patients with non-dysplastic BO should have surveillance endoscopy every 3–5 years, whereas dysplastic BO should be ablated endoscopically. Any nodule in the BO should be removed by endoscopic mucosal resection. Patients with BO should be on life-long acid-suppressant therapy. Non-invasive techniques such as the Cytosponge are being investigated as an alternative to endoscopy for BO screening.