Diagnosis

Endoscopic visualisation and biopsy are diagnostic

• Barrett’s oesophagus is diagnosed when salmon coloured mucosa is clearly visualised to extend ≥1 cm above the gastro-oesophageal junction
• diagnosis is confirmed when histopathological examination shows specialised columnar epithelium or inestinal metaplasia (1,2).

Once Barrett’s oesophagus is diagnosed, the aim is to detect dysplasia which is an indication of cancer.

• to identify dysplasia, endoscopic biopsies are obtained according to the Seattle protocol (four quadrant biopsies per 2 cm length of Barrett’s oesophagus) in addition to targeted biopsies of any visible lesion.
• dysplasia can be described as
  • negative for dysplasia
  • indefinite for dysplasia
  • low grade dysplasia
  • high grade dysplasia

The addition of p53 immunostaining to the histopathological assessment may improve the diagnostic reproducibility of a diagnosis of dysplasia in Barrett’s oesophagus and should be considered as an adjunct to routine clinical diagnosis (3)

Reference:

• (1) Shaheen NJ et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016;111(1):30-50
• (2) Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ. 2016;353:i2373
• (3) Fitzgerald RC et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014;63(1):7-42