Barrett's oesophagus

Barrett's oesophagus (or columnar lined epithelium of the oesophagus) is the precursor lesion for oesophageal adenocarcinoma which is a cancer with a very poor prognosis. The clinical accessibility of the Barrett's segment and the opportunity for repeated, longitudinal sampling make it an ideal system in which to study the pathogenesis of metaplasia and the progression to cancer. From a clinical standpoint there has been much controversy over how to manage patients with this condition since it is often clinically silent, only a minority of patients will progress to cancer and until recently the treatment options have been limited and highly invasive. The two key clinical questions are therefore: how to identify patients with Barrett's oesophagus who are at high risk for progression to adenocarcinoma and how to manage those at high risk in order to prevent cancer development. It is also possible that if one had a thorough understanding of the disease pathogenesis then maybe one could prevent individuals with duodeno-gastro-oesophageal reflux developing Barrett's oesophagus in the first place. The explosion in endoscopic technology coupled with molecular biology tools at the -omics level mean that advances are being made which are having an impact on clinical practice although the field remains dogged by a lack of consensus in many areas. © 2011 Springer Science+Business Media, LLC.