Thirty-one patients with a columnar lined oesophagus were studied. Half the patients were aged 70 years or over and only four patients were under 60 years of age at presentation. More than two-thirds of patients presented with a complication. Comparison by age showed a significant difference (P = 0.006) between the nine patients with uncomplicated Barrett's oesophagus (median age 64 years, range 28-79 years) and the 22 presenting with a complication (median age 75 years, range 36-89 years). This finding supports the view that the condition is acquired and that complications occur after injury resulting from prolonged reflux. Five patients (16%) had a carcinoma. Of the remaining 26 patients only seven (27%) underwent an antireflux procedure. Old age, associated medical problems and the effective control of symptoms by medical management (drugs and dilatation), reduced the need for surgery in this elderly population.
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