Barrett's Oesophagus J032

Current RMA Instruments:

SOP bulletin information on new Instruments:

ICD Coding:

• ICD-9-CM Codes: 530.85
• ICD-10-AM Codes: K22.7

Brief description

This SOP covers a condition in which the normal epithelium (lining) of the lower oesophagus is replaced by abnormal (metaplastic columnar) epithelium, which predisposes to the development of oesophageal cancer.  The condition typically develops as a consequence of chronic gastro-oesophageal reflux disease.

Confirming the diagnosis

Diagnosis requires endoscopic visualisation of columnar epithelium in the distal oesophagus (which has a characteristic salmon colour) plus histological confirmation of metaplasia, on biopsy.

The relevant medical specialist is a gastroenterologist. 

Additional diagnoses covered by SOP

• Barrett oesophagus

Conditions not covered by SOP

• Gastro-oesophageal reflux disease*
• Barrett's ulcer ^#

* another SOP applies

^# non-SOP condition - this is a peptic ulcer arising in the oesophagus in abnormal (Barrett's) epithelium.  It is a separately diagnosed and treated condition (ICD codes 530.2 / K22.1).

Clinical onset

Clinical onset will be when the condition was first confirmed by endoscopy and histology.  The condition is asymptomatic and so onset cannot be determined from the clinical presentation.

Clinical worsening

Clinical worsening may be evidenced by progression from metaplastic epithelium to dysplastic epithelium or from a lower to a higher grade of dysplasia (histology required to confirm).  The development of adenocarcinoma represents the onset of a new condition rather than worsening of Barrett's oesophagus.

Therapy is available that can alter the course of the condition.  Drug treatment is aimed at controlling acid reflux, particularly with proton pump inhibitors and reducing risk of progression to dysplasia.  Ongoing survelliance in higher risk individuals and further treatment (including excision, ablation and cryotherapy) is directed at reducing the risk of progression to adenocarcinoma.