Clinical Practice Guidelines

Diagnosis and management of Barrett's columnar-lined oesophagus

Biritish Society of Gastroenterology

A Report of the Working Party of the British Society of Gastroenterology, principal authors: A Watson, RC Heading, NA Shepherd

Barrett's oesophagus, or columnar-lined oesophagus (CLO) as it is more appropriately known, owes its importance to being a precursor lesion of oesophageal adenocarcinoma, the incidence of which has increased threefold in the last decade and tenfold in the last three decades and currently has the most rapidly increasing incidence of any solid tumour in the western world. Major challenges include the identification of molecular markers of risk of adenocarcinoma development at an earlier stage than high grade dysplasia, the efficacy and cost-effectiveness of surveillance and the most appropriate management of CLO and high grade dysplasia. Furthermore, the fact that CLO complicates severe and long- standing gastro-oesophageal reflux disease (GORD) and the finding that GORD can predispose to adenocarcinoma, apparently without necessarily progressing through CLO, raise the question as to whether screening of patients with severe long-standing GORD is appropriate.

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Southern Gastro Group: Specialists in Gastroenterology