To the Editor: I wish Professor Carr the very best in his attempt to eliminate the somewhat confusing term “Barrett’s oesophagus” from the literature.1

Changing well entrenched medical nomenclature is difficult, however. I tried to do this with “microscopic colitis” 10 years ago2 but was not successful. After all, I argued, we do not speak of “microscopic bronchitis” or “microscopic salpingitis” — so why should we have the term microscopic colitis?

It is nonetheless pleasing to note that the definition of microscopic colitis has tightened up over the past 10 years,3 and I think this may be a more realistic aim for Professor Carr with the term Barrett’s oesophagus.

Admittedly, the two entities are not perfectly analogous, as, unlike microscopic colitis, Barrett’s oesophagus is classically associated with abnormally coloured mucosa. However, in both entities, the endoscopist usually takes biopsies from endoscopically flat mucosa, specifically looking for the disease in question.

I am not sure I can see myself in 10 years’ time looking down someone’s oesophagus and saying, “I think there may be some columnar metaplasia down there. I wonder if there is some intestinal metaplasia as well?” Maybe this would be a good conversation opener in the halls of the pathology department, but certainly not in the endoscopy suite! I think I will still be saying, “That looks like Barrett’s, but we will need to take biopsies to make sure”.

In reply: I thank Dr Thomson for his kind comments. I sympathise with his attempts to eliminate the term “microscopic colitis”1,2 and would happily join him in this campaign. I agree it is important to tighten up the definitions of ambiguous terms. For example, “indeterminate colitis” is another term that continues to be used in different ways, despite attempts to clarify its definition.3

However, in the case of Barrett’s oesophagus, there are precise definitions, but they are mutually exclusive. The British Society of Gastroenterology uses one definition (not requiring goblet cells), whereas other national bodies use another definition (requiring the demonstration of goblet cells histologically).4 Therefore, when an endoscopist says “That looks like Barrett’s”, he or she could be saying either that the mucosa appears glandular or that a pathologist will find goblet cells in it. The two are not the same and we should not confuse them.

I believe we should not use “Barrett’s oesophagus” because it is defined differently by different people; confusion regarding the site of a particular biopsy can cause it to be applied inappropriately; and we have existing terminology that does the job.

I accept that a few lone voices are not going to change well entrenched terminology. However, we can hope that the national and international bodies that construct guidelines in this area will take heed, accept the challenge and deal with the problem.