ABSTRACT
The columnar-lined (Barrett’s) esophagus, named after Norman “Pasty” Barrett has become one of the most fascinating conditions in gastrointestinal oncology. It has a very distinctive endoscopic appearance and is an intriguing pathological change. It would be of academic interest only were it not for its potential to degenerate to esophageal adenocarcinoma. There is currently a worrying rise in the annual incidence of this cancer (1,2), which is matched by little change in the effects of treatment on the mortality. The median survival was 0.75 years (1973-1977) and has improved to 0.9 years (1993-1999) (3). Various risk factors for degeneration to cancer have been identified, and it is a particular and increasing problem for white men in England and Scotland (4). Currently, 0.5% to 1% of adults with Barrett’s metaplasia will progress to cancer. The annual conversion to adenocarcinoma for patients with long segments (>3 cm of Barrett’s metaplasia) is 1% in the United Kingdom (5). Despite family clusters, there seem no obvious inheritable genetic factors. If this trend continues, there is little prospect of altering the impact modern medicine will have on this disease, despite the introduction of neoadjuvant therapy with chemoradiation and improved surgical outcomes. It is postulated that the incidence and mortality will remain closely matched (Fig. 1).
