Synopsis
Apply current NICE surveillance intervals and Seattle biopsies, distinguish non-dysplastic, indefinite and confirmed dysplastic Barrett mucosa, and select endoscopic eradication or surgery by invasion risk.
- Barrett oesophagus is visible columnar-lined distal oesophagus of at least 1 cm confirmed histologically, arising in the setting of reflux and carrying adenocarcinoma risk.
- Use high-resolution white-light surveillance with Seattle protocol biopsies plus targeted sampling of every visible abnormality.
- NICE offers surveillance every two to three years for segments at least 3 cm and every three to five years for short segments under 3 cm with intestinal metaplasia.
Key red flags
Dysplasia should be confirmed by expert gastrointestinal pathologists before irreversible eradication treatment.
New dysphagia, bleeding or weight loss during surveillance triggers diagnostic escalation rather than merely shortening the routine interval.
A focal abnormality needs endoscopic resection for staging before residual-field ablation.
Investigation priorities
Inspect the whole segment and identify visible neoplasia.
Management branches
A fit person has a 4 cm non-dysplastic Barrett segment with intestinal metaplasia.
- Discuss the benefit, procedural risk and limitations of surveillance.
- Offer high-resolution endoscopy with Seattle biopsies every two to three years, tailored within that range to individual cancer risk.
Key medicines
Omeprazole for coexisting refluxTreat the separate reflux indication rather than Barrett metaplasia itself: for uncomplicated symptomatic GORD use omeprazole 20 mg orally once daily before food for four weeks, extending to eight weeks if needed. For severe reflux oesophagitis use 40 mg once daily for eight weeks and continue long-term full-dose 40 mg once daily after healing; symptom-led step-down applies to uncomplicated disease.Swallow the gastro-resistant tablet whole with water and do not chew or crush it. Nelfinavir is contraindicated and concomitant clopidogrel is discouraged; hepatic impairment may require a lower dose. Review long-term safety and interactions, and do not imply that a PPI removes the need for indicated Barrett surveillance or dysplasia treatment.