When cells lining the lower oesophagus change from their normal morphology into that similar to cells in the stomach, it is referred to as Barrett’s oesophagus (BO). This occurs in response to abnormal exposure to acid reflux from the stomach (See Gastro-oesophageal reflux disease).
The clinical significance of diagnosing BO is that it is considered a “pre-malignant” condition and it increases the risk of oesophageal cancer developing. The diagnosis of BO may be difficult, and relies on certain endoscopic and histopathological findings. Barrett's oesophagus may be misdiagnosed if biopsies are taken from incorrect sites or if endoscopic findings are misinterpreted. As such, care should be taken when making this diagnosis. An incorrect diagnosis may result in much unnecessary concern by the patient and many unnecessary endoscopies.
The risk of developing oesophageal cancer from BO is classified according to:
- The distance of the margin of the cellular changes in the oesophagus
- The degree of pre-malignant change (dysplasia)
Depending on these changes, recommended management varies from observation with endoscopy (See Gastroscopy) at set intervals (for no or low grade dysplasia), to endoscopic ablation and resection (for high grade dysplasia), and even surgical resection of part of the oesophagus if invasive cancer is found.