Barrett Oesophagus J032

Current RMA Instruments:

Changes from previous Instruments:

ICD Coding:

• ICD-10-AM Codes: K22.7

Brief description

Barrett oesophagus is a condition in which the normal stratified squamous lining of the lower oesophagus is replaced by abnormal columnar epithelium (a process known as metaplasia). 

This metaplastic change may also occur at the gastro-oesophageal junction, and is clinically important because it increases the risk of progression to oesophageal cancer. Barrett oesophagus most commonly arises as a consequence of long-standing gastro-oesophageal reflux disease (GORD).

Confirming the diagnosis

Diagnosis requires endoscopic visualisation of the lining of the lower oesophagus, which typically shows salmon-coloured columnar mucosa extending above the gastro-oesophageal junction.

Definitive confirmation also requires histological evidence of metaplasia on biopsy, demonstrating the replacement of normal squamous epithelium with columnar epithelium. 

Assessment and ongoing management are usually undertaken by a gastroenterologist, who is the relevant medical specialist for confirming the diagnosis and guiding surveillance. General practitioners can also confirm this diagnosis based on histological evidence. 

Additional diagnoses covered by SOP

• Barrett oesophagus

Conditions not covered by SOP

• Gastro-oesophageal reflux disease *
• Barrett's ulcer # - this is a peptic ulcer arising in the oesophagus in abnormal (Barrett) epithelium.  It is a separately diagnosed and treated condition.

* another SOP applies

# non-SOP condition 

Clinical onset

Clinical onset of Barrett oesophagus is the time when the condition is first confirmed by endoscopy and histology. Because Barrett oesophagus is typically asymptomatic, onset cannot be determined based on symptoms or clinical presentation alone. It is most often detected during endoscopy performed for other reasons, such as investigation of reflux symptoms. 

Clinical worsening

Clinical worsening may be demonstrated by histological progression from metaplastic to dysplastic epithelium, or by progression from low-grade to high-grade dysplasia. These changes require repeat endoscopy and biopsy for confirmation.

The development of oesophageal adenocarcinoma represents the onset of a new and separate condition, not worsening of Barrett oesophagus. 

Several therapeutic approaches can modify the course of Barrett oesophagus. Pharmaceutical treatment- most commonly proton pump inhibitors- is aimed at controlling acid reflux and reducing the risk of progression to dysplasia. In individuals with higher- risk disease, surveillance endoscopy is recommended, and additional interventions such as endoscopic resection, radiofrequency ablation, or cryotherapy may be used to reduce the likelihood of progression to adenocarcinoma.