Just a few years ago, the definition and pathogenesis of Barrett’s oesophagus seemed straightforward. Barrett’s oesophagus was the condition in which metaplastic columnar epithelium replaced oesophageal squamous mucosa that had been damaged by exposure to refluxed gastric juice. The condition was sought primarily in patients with gastro-oesophageal reflux disease (GORD), and was identified when endoscopic examination revealed long segments of columnar epithelium extending well up the oesophagus. Biopsy specimens taken from the oesophageal columnar lining usually showed a peculiar form of intestinal metaplasia called specialised columnar epithelium or specialised intestinal metaplasia. In patients who developed adenocarcinomas in Barrett’s oesophagus, the columnar epithelium surrounding the oesophageal tumour invariably contained specialised intestinal metaplasia that often exhibited dysplastic changes. Eventually, Barrett’s oesophagus with specialised intestinal metaplasia became recognised as the major risk factor for adenocarcinoma of the oesophagus and oesophagogastric junction.1

Over the past two decades, the incidence of adenocarcinoma of the oesophagus and oesophagogastric junction has been rising dramatically in the United …