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Although the risk of oesophageal adenocarcinoma is increased, this cancer is an uncommon cause of death in patients with Barrett’s oesophagus
In a Gut Commentary in 1997, Spechler1 observed that neither the definition nor the pathogenesis of Barrett’s oesophagus were as straightforward as they had seemed only a few years earlier. Today, it looks as if oesophagologists need recourse to the black arts of journalistic spin if recent research on Barrett’s is to be portrayed as bringing clarity to the subject, because in truth it has not had much success in resolving the major uncertainties about pathogenesis, clinical significance, and optimum patient management. Regrettably, we are still unable to answer very many important scientific and practical questions. For example, why do some patients with gastro-oesophageal reflux disease (GORD) develop Barrett’s whereas others do not? What determines the length of the columnar segment? Why does it not lengthen with time despite continuing reflux? Is Barrett’s the important precursor of oesophageal adenocarcinoma or is severe reflux the real risk factor irrespective of overt metaplasia of the epithelium? Is endoscopic surveillance of Barrett’s oesophagus an essential part of good clinical practice or is it a waste of time and money? This is …