Barrett's oesophagus is the erosive replacement of the normal squamous oesophageal epithelium with a columnar, glandular phenotype due to chronic acid/bile reflux. It is often referred to as an 'intestinal metaplasia' however this does not fully describe the condition.
The term 'Barrett's oesophagus' encompasses a broad range of epithelial phenotypes ranging from entirely gastric differentiated epithelial content to entirely intestinal. The most common types are called 'specialized' and 'cardiac'. Specialized epithelium contains both gastric-type cells (foveolar, mucous secreting cells) and intestinal-type (goblet cells), where as cardiac-type (also known as columnar-lined oesophagus) only contains foveolar and mucous-secreting cells. The other types range from an atropic corpus type that contains acid- and pepsin-secreting cells, to a mature intestinal type that also contains Paneth cells that produce anti-microbial peptides.
Barrett's oesophagus is the only know precursor condition of oesophageal adenocarcinoma. Both are diagnosed endoscopically and patients with Barrett's are enrolled into an endoscopic surveillance programme where biopsies are routinely taken to determine if cancer or pre-cancer (dysplasia) changes have occurred. The hope is that pre-cancer changes are detected sufficiently early that it can be removed by either dissection or by radio frequency ablation. Patient survival is excellent if diagnosed early. Unfortunately, oesophageal adenocarcinoma metastasises quickly and if it is not diagnosed early, treatment is by drastic surgery with neo-adjuvant chemotherapy or radiotherapy that can have a poor long term outcome.
Most patients with Barrett's oesophagus do not develop adenocarcinoma, however most patients with adenocarcinoma never receive a diagnose of Barrett's. It is therefore critical that we research and develop better predictive and diagnostic biomarkers. My research focuses on how we can identify those with Barrett's that have a high probability of developing cancer for earlier treatment and those with a low or no risk that do not require surveillance.
The term 'Barrett's oesophagus' encompasses a broad range of epithelial phenotypes ranging from entirely gastric differentiated epithelial content to entirely intestinal. The most common types are called 'specialized' and 'cardiac'. Specialized epithelium contains both gastric-type cells (foveolar, mucous secreting cells) and intestinal-type (goblet cells), where as cardiac-type (also known as columnar-lined oesophagus) only contains foveolar and mucous-secreting cells. The other types range from an atropic corpus type that contains acid- and pepsin-secreting cells, to a mature intestinal type that also contains Paneth cells that produce anti-microbial peptides.
Barrett's oesophagus is the only know precursor condition of oesophageal adenocarcinoma. Both are diagnosed endoscopically and patients with Barrett's are enrolled into an endoscopic surveillance programme where biopsies are routinely taken to determine if cancer or pre-cancer (dysplasia) changes have occurred. The hope is that pre-cancer changes are detected sufficiently early that it can be removed by either dissection or by radio frequency ablation. Patient survival is excellent if diagnosed early. Unfortunately, oesophageal adenocarcinoma metastasises quickly and if it is not diagnosed early, treatment is by drastic surgery with neo-adjuvant chemotherapy or radiotherapy that can have a poor long term outcome.
Most patients with Barrett's oesophagus do not develop adenocarcinoma, however most patients with adenocarcinoma never receive a diagnose of Barrett's. It is therefore critical that we research and develop better predictive and diagnostic biomarkers. My research focuses on how we can identify those with Barrett's that have a high probability of developing cancer for earlier treatment and those with a low or no risk that do not require surveillance.
Cardiac type (columnar-lined) Specialized epithelium Dysplasia
All images are ©Stuart McDonald, Queen Mary University of London
All images are ©Stuart McDonald, Queen Mary University of London
Charities associated with Barrett's oesophagus and oesophageal cancer