Barrett's oesophagus: a clinical study of 52 patients.Q J Med 1987; 62(238):97-108QJ
This paper reports a series of 52 patients with Barrett's (or columnar-lined) oesophagus from one medical unit diagnosed over a six-year period. The commonest associated symptoms were heartburn, regurgitation and dysphagia but 10 patients had no oesophageal symptoms and two had no symptoms at all. Gastrointestinal bleeding (overt or occult) was observed in almost one-third of patients. At diagnosis, 26 patients had oesophagitis, 23 had oesophageal ulceration and 10 had benign oesophageal strictures. An association between oesophageal ulceration and non-steroidal anti-inflammatory drug ingestion was suggested by the data and patients with oesophageal ulceration were significantly older than patients with uncomplicated Barrett's oesophagus. No patient had adenocarcinoma of the oesophagus at diagnosis and neither carcinoma nor dysplasia were seen during a mean period of 16.4 months. However, 17 per cent of patients in the series had malignancies in other sites. Most patients did well on medical treatment and only two were referred for anti-reflux surgery (both for non-healing oesophageal ulcers). Barrett's oesophagus was seen in 10 per cent of patients with gastro-oesophageal reflux at endoscopy. Oesophageal ulceration in patients with Barrett's oesophagus made up 21 per cent of oesophageal ulcers seen and benign oesophageal stricture in patients with Barrett's oesophagus constituted 13 per cent of all benign strictures seen. Barrett's oesophagus is common in our population and despite complications, it can be managed successfully, at least in the short term, by conservative means.