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Barrett oesophagus

Nature Reviews Disease Primers volume 5, Article number: 35 (2019) Cite this article

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Abstract

Barrett oesophagus (BE), the only known histological precursor of oesophageal adenocarcinoma (EAC), is a condition in which the squamous epithelium of the oesophagus is replaced by columnar epithelium as an adaptive response to gastro-oesophageal reflux. EAC has one of the fastest rising incidences of cancers in Western countries and has a dismal prognosis. BE is usually detected during endoscopic examination, and diagnosis is confirmed by the histological presence of intestinal metaplasia. Advances in genomics and transcriptomics have improved our understanding of the pathogenesis and malignant progression of intestinal metaplasia. As the majority of EAC cases are diagnosed in individuals without a known history of BE, screening for BE could potentially decrease disease-related mortality. Owing to the pre-malignant nature of BE, endoscopic surveillance of patients with BE is imperative for early detection and treatment of dysplasia to prevent further progression to invasive EAC. Developments in endoscopic therapy have resulted in a major shift in the treatment of patients with BE who have dysplasia or early EAC, from surgical resection to endoscopic resection and ablation. In addition to symptom control by optimization of lifestyle and pharmacological therapy with proton pump inhibitors, chemopreventive strategies based on NSAIDs and statins are currently being investigated for BE management.

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Fig. 1: Development and progression of Barrett oesophagus.
Fig. 2: Pathogenesis of Barrett oesophagus.
Fig. 3: Mechanisms of malignant progression in Barrett oesophagus.
Fig. 4: Endoscopic diagnosis of Barrett oesophagus.
Fig. 5: Histopathological features of Barrett oesophagus.
Fig. 6: Screening techniques for Barrett oesophagus.
Fig. 7: Algorithm for management of non-dysplastic and dysplastic Barrett oesophagus.
Fig. 8: Endoscopic approaches for treatment of Barrett oesophagus.

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Acknowledgements

The authors thank R. S. van der Post and M. O’Donovan for providing the histopathological images.

Reviewer information

Nature Reviews Disease Primers thanks S. McDonald, A. Bansal, M. Jansen, R. Odze, K. Krishnadath, H. Barr and the other anonymous reviewer(s), for their contribution to the peer review of this work.

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Author notes

  1. These authors contributed equally: Yonne Peters, Ali Al-Kaabi

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands

    Yonne Peters, Ali Al-Kaabi & Peter D. Siersema

  2. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Nicholas J. Shaheen

  3. Division of Gastroenterology and Liver Diseases, Case Western Reserve University, Cleveland, OH, USA

    Amitabh Chak & Andrew Blum

  4. Department of Medicine and the Center for Esophageal Diseases, Baylor University Medical Center at Dallas and the Center for Esophageal Research, Baylor Scott and White Research Institute, Dallas, TX, USA

    Rhonda F. Souza

  5. Medical Research Council Cancer Unit, University of Cambridge, Cambridge, UK

    Massimiliano Di Pietro & Rebecca C. Fitzgerald

  6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Prasad G. Iyer

  7. Department of Gastroenterology, St John of God Hospital, Regensburg, Germany

    Oliver Pech

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Contributions

Introduction (Y.P. and A.A.-K.); Epidemiology (Y.P. and N.J.S.); Mechanisms/pathophysiology (A.A.-K., A.C., A.B. and R.F.S.); Diagnosis, screening and prevention (Y.P., M.D.P., P.G.I. and R.C.F.); Management (Y.P., A.A.-K. and O.P.); Quality of life (Y.P.); Outlook (Y.P., A.A.-K. and P.D.S.); Overview of Primer (Y.P., A.A.-K. and P.D.S.).

Corresponding author

Correspondence to Peter D. Siersema.

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Competing interests

N.J.S. has received research grants from Medtronic, CSA Medical, C2 Therapeutics, CDx Medical, EndoStim and Interpace Diagnostics and has served as a consultant for Pfizer, Boston Scientific and Shire. A.C. has equity interest in and is a consultant for Lucid Diagnostics. R.F.S. has served as a consultant and receives research support from Ironwood Pharmaceuticals. M.D.P. has received educational grants from Olympus and Medtronic and has served as consultant for Medtronic. P.G.I. has received research funding from Exact Sciences, Pentax Medical, Symple Surgical, Nine Point Medical and Medtronic and has served as a consultant for Medtronic, Symple Surgical and CSA Medical. O.P. has a speaker honorarium from Olympus, Fujifilm, Medtronic, Boston Scientific and Cook. R.C.F. is named on patents related to the Cytosponge and associated assays, which have been licensed to Covidien (now Medtronic), and has served as a consultant to Medtronic. P.D.S. has received research funding from Pentax Medical, EndoStim, Yakult, OncoDNA and Ella-CS. Y.P., A.A.-K. and A.B. declare no competing interests.

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Peters, Y., Al-Kaabi, A., Shaheen, N.J. et al. Barrett oesophagus. Nat Rev Dis Primers 5, 35 (2019). https://doi.org/10.1038/s41572-019-0086-z

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