History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include acid-bile reflux or GORD, increased age, white ethnicity, and male sex.

heartburn

Typical symptom of GORD, the presence of which is essential for the development of Barrett's oesophagus.

regurgitation

Typical symptom of GORD, the presence of which is essential for the development of Barrett's oesophagus.

uncommon

dysphagia

May indicate stricture (benign or malignant) or oesophageal motility disorders.

Other diagnostic factors

uncommon

incidental finding during gastrointestinal endoscopy for other indication

Barrett's oesophagus may be asymptomatic and detected incidentally during endoscopy for another indication.

chest pain

Atypical GORD symptom.

laryngitis

Atypical GORD symptom.

cough

Atypical GORD symptom.

dyspnoea or wheezing

Reflux-induced asthma or reactive airway disease are atypical manifestations of GORD.

history of aspiration pneumonia

Atypical manifestation of GORD.

Risk factors

strong

acid/bile reflux or GORD

Barrett's oesophagus does not develop in the absence of reflux. Both epidemiological and molecular biological evidence supports this association.[2][3][4][12][13][19][23] A meta-analysis of 26 studies found that the presence of GORD-related symptoms increased the risk of long-segment Barrett’s oesophagus fivefold, but seemed to have little association with short-segment Barrett’s oesophagus. However, it was noted that the study results were quite heterogeneous.[24]

increased age

In general, increased age is associated with an increased prevalence of Barrett's oesophagus.[6]​[10][23]​[25]​​​​

white ethnicity

The majority of cases are found in white patients.[10][23]

male sex

Men have an almost twofold increased risk as compared with women.[6][8]​​​​​[11]​​[23]​[26]​

weak

family history of Barrett's oesophagus or oesophageal adenocarcinoma

A risk factor for a minority of patients. Of those with Barrett's oesophagus, oesophageal adenocarcinoma, or gastro-oesophageal junction adenocarcinoma, 7.3% will have at least one first or second degree relative with Barrett's oesophagus. Specifically, 6.2% of patients with Barrett's oesophagus, 9.5% of patients with oesophageal adenocarcinoma, and 9.5% of patients with gastro-oesophageal junction adenocarcinoma will have such a relation.[27]

obesity

Obesity has been shown to increase the odds ratio of harbouring Barrett's oesophagus.[23][28][29]

smoking

Prevalence of Barrett's oesophagus among smokers is higher than in non-smokers, is mainly related to the increased prevalence of GORD in the former group.[6]​[30]​​

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