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Barrett’s oesophagus
Nicholas J Shaheen, Joel E Richter
Lancet 2009; 373:850–61 Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, NC, USA (N J Shaheen MD) and Division of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA (Prof J E Richter MD) Correspondence to: Dr Nicholas Shaheen, CB#7080, UNC-CH, Chapel Hill, NC 27599, USA nshaheen@med.unc.edu

Barrett’s oesophagus is a metaplastic change of the lining of the oesophagus, such that the normal squamous epithelium is replaced by specialised or intestinalised columnar epithelium. The disorder seems to be a complication of chronic
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In Barrett’s oesophagus, salmon-coloured epithelium projects into the tubular oesophagus. These projections might present as tongues of tissue (figure 1C), or as circumferential involvement of the mucosa (figure 2), or both. The second criterion for diagnosis is intestinalised epithelium, or epithelium containing goblet cells (figure 1D), in a biopsy specimen of the tubular oesophagus. Whether identification of goblet cells in the metaplastic epithelium is necessary for diagnosis is debatable—US societies and authorities require identification6,7,8 but the British Society of Gastroenterology does not.9 Metaplastic tissue with or without goblet cells has been termed columnar lined epithelium. For clarity, oesophageal epithelium with the endoscopic appearance of Barrett’s oesophagus, but without histological confirmation, should be termed endoscopically suspected oesophageal metaplasia.10 The length of the displaced squamocolumnar junction should be measured during endoscopy: longer than 3 cm is long-segment Barrett’s oesophagus; 3 cm or shorter is short-segment Barrett’s oesophagus.11,12 Previously, investigators have suggested that short segments are not clinically significant, but other research has shown an increased cancer risk in even short-segment disease compared with the general population.11,13 Therefore, the most common current definition of Barrett’s oesophagus is salmon-coloured mucosa of any length in

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