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Barrett’s oesophagus: epidemiology, diagnosis and clinical management

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In most industrialised countries, including Australia, the incidence of oesophageal adenocarcinoma has increased fivefold in the past 40 years.1 Almost all of these cancers arise from underlying Barrett’s oesophagus,2 a condition described by Australian-born Norman Barrett in 19573 in which the normal oesophageal squamous epithelium is partially replaced by an intestinal metaplastic columnar epithelium. This narrative review discusses the epidemiology of Barrett’s oesophagus and its relationship to cancer, considers recent developments around screening and surveillance, and briefly reviews the management of dysplasia and early adenocarcinoma arising in Barrett’s oesophagus. It is based on comprehensive Australian guidelines recently published by Cancer Council Australia (http://wiki.cancer.org.au/australia/Guidelines: Barrett%27s).4


In the Australian guidelines (as in most other international guidelines), a diagnosis of Barrett’s oesophagus requires two components: first, endoscopic evidence of a salmon-pink coloured columnar epithelium extending above the gastro-oesophageal junction and partially replacing the normal tubular oesophageal squamous epithelium; and second, biopsies from…