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Textbook/Gastroenterology and hepatology/Barrett oesophagus and surveillance/Rapid
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Barrett oesophagus and surveillance

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Barrett oesophagus itself is not an emergency, but new progressive dysphagia, food obstruction, haematemesis, melaena, substantial anaemia, persistent vomiting or weight loss needs urgent investigation rather than waiting for scheduled surveillance. A visible ulcer, nodule or cancer-suspicious lesion at endoscopy requires targeted biopsy or endoscopic resection planning and prompt upper-GI cancer MDT referral. Do not reassure from a recent non-dysplastic biopsy when new alarm symptoms have appeared.

Synopsis

Explain Barrett oesophagus risk accurately, deliver evidence-based surveillance and route dysplasia to expert endoscopic therapy without overtreating non-dysplastic disease.

  • Barrett oesophagus is endoscopically visible columnar-lined distal oesophagus confirmed histologically; document the gastro-oesophageal junction and circumferential and maximal extent consistently.
  • It increases oesophageal adenocarcinoma risk, but the absolute annual risk for an individual with non-dysplastic Barrett is low and should be explained without alarmism.
  • Surveillance aims to detect dysplasia or early cancer when endoscopic cure is possible; it is not a guarantee against cancer.

Key red flags

Confirmed low-grade dysplasia

Expert pathology confirms low-grade change and the finding persists on the required separate endoscopic sampling, substantially increasing progression risk and prompting specialist ablation discussion.

Investigation priorities

01
High-resolution white-light endoscopyFirst step

Define landmarks, segment length, inflammation and visible neoplasia.

Management branches

Surveillance entryConfirm that Barrett surveillance is appropriate

Columnar mucosa is reported at an index endoscopy.

  1. Verify endoscopic landmarks, measured segment length and histological metaplasia, distinguishing true Barrett from an irregular Z-line or gastric-cardia sampling.
  2. Review dysplasia through expert pathology where present and ensure active inflammation or a visible lesion has not made the baseline examination unreliable.

Key medicines

Proton pump inhibitor for coexisting refluxUse a licensed full-dose PPI such as omeprazole 20 mg orally once daily for symptomatic GORD, adjusting to healing and the lowest effective maintenance dose under NICE and product guidance.
Aspirin is not Barrett chemopreventionDo not start aspirin solely to prevent progression of Barrett oesophagus; if prescribed for another indication, use the evidence-based dose from that cardiovascular or specialist pathway.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom