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Abstract
Barrett's oesophagus is a metaplastic change of the lining of the oesophagus, such
that the normal squamous epithelium is replaced by specialised or intestinalised columnar
epithelium. The disorder seems to be a complication of chronic gastro-oesophageal
reflux disease, although asymptomatic individuals might also be affected, and it is
a risk factor for the development of oesophageal adenocarcinoma, a cancer with rapidly
increasing incidence in developed societies. We review the presentation, epidemiology,
and risk factors for this condition. We discuss the molecular changes necessary for
the development of Barrett's oesophagus and its progression to cancer, and new strides
in both the endoscopic detection of the lesion and the treatment of dysplastic disease.
Also, we assess the effectiveness of efforts to screen patients at risk of Barrett's
oesophagus, and whether such efforts avert cancer death. We conclude with a discussion
of future directions for research, focusing on treatment of early neoplasia, and modifications
of current practices to show our evolving understanding of this condition.