Volume 188 - Issue 8
Barrett’s oesophagus and columnar metaplasia: saying what we mean
Author: Norman J Carr
Med J Aust 2008; 188 (8): 495-496. || doi: 10.5694/j.1326-5377.2008.tb01741.x
Published online: 21 April 2008
Published online: 21 April 2008
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.
References
- Thomson A. Microscopic colitis — no longer an appropriate term? Am J Gastroenterol 1998; 93: 524-526. 0_CBBHICBA
- Thomson A. Microscopic colitis: not just for aristocrats. J Gastroenterol Hepatol 2007; 22: 773-774. 0_i1091825
- Tremaine WJ. Review article: indeterminate colitis — definition, diagnosis and management. Aliment Pharmacol Ther 2007; 25: 13-17. 0_i1091827
- Carr NJ. Barrett’s oesophagus and columnar metaplasia: saying what we mean. Med J Aust 2007; 187: 519-521. 0_i1091830
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