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The value of surveillance and other unresolved issues in the management of Barrett's esophagus

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 60–61 (2005)Cite this article

The basic requirements for diagnosing Barrett's esophagus have changed over time. Previously, the affected segment had to cover ≥3 cm, but length is no longer thought to have a major influence on the risk of developing carcinoma.1 Similarly, histologic confirmation previously only required the presence of columnar cells, but most definitions now also require identification of intestinal metaplasia. Virtually all patients with a segment of columnar-lined esophagus >3 cm will have areas of intestinal metaplasia if enough biopsy samples are taken, although it is unclear if this holds true for shorter segments. As esophageal adenocarcinoma probably develops from areas of intestinal metaplasia, there is likely to be a higher risk if more intestinal metaplasia is present. Barrett's esophagus should not be confused with the presence of intestinal metaplasia at the gastroesophageal Z line. The relevance of this condition, which is sometimes termed ultrashort Barrett's esophagus, is uncertain.

Reflux of gastroduodenal contents is probably the major contributor to the development of Barrett's esophagus, although the relative contribution of acid versus duodenal contents, particularly bile, is unclear. Depending on how Barrett's esophagus is defined, 0.25–2% of the population and about 10% of patients who undergo endoscopy for symptoms of longstanding reflux have the condition2, although some studies suggest that this might be an underestimate.

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  1. Professor of Gastroenterology at Hammersmith Hospitals NHS Trust, London, UK

    Raymond J Playford

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  1. Raymond J Playford
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Correspondence to Raymond J Playford.

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Raymond Playford is an external consultant for GlaxoSmithKline.

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Playford, R. The value of surveillance and other unresolved issues in the management of Barrett's esophagus. Nat Rev Gastroenterol Hepatol 2, 60–61 (2005). https://doi.org/10.1038/ncpgasthep0088

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