Dilemmas in managing Barrett's oesophagus

In the UK, oesophageal adenocarcinoma accounts for over 7,000 deaths per year and its incidence is rising. One risk factor for this cancer is Barrett's oesophagus. In this condition, reflux of acid and duodenal fluid leads to replacement of the normal stratified squamous epithelium with a columnar epithelium. This new epithelium includes areas of intestinal metaplasia that may develop into dysplasia and ultimately carcinoma. Of people with Barrett's oesophagus, about 1% per year develop adenocarcinoma, around 30-125 times the rate in the general population. This carcinoma is asymptomatic until locally advanced, and has a poor prognosis unless detected early. So it has been suggested that people with reflux should be screened for Barrett's oesophagus, and those with the condition should be kept under surveillance to detect dysplasia or adenocarcinoma in the early stages. Here we discuss the problems in managing patients with Barrett's oesophagus.