1.2. Oesophageal Disease - Barrett's Oesophagus

Question 1

What is the cause of Barrett’s Oesophagus?

Answer 1

This is a late-stage continuation of Gastro-Oesophageal Reflux Disease (GORD)

Question 2

What is the Pathology of Barrett’s Oesophagus?

Answer 2

1. The Oesophageal Mucosa are chronically exposed to Gastric Acid / Pepsin
2. Metaplasia of the Oesophageal Mucosa occurs

Question 3

What does the Mucosa change from / to?

Answer 3

From - Stratified Squamous Epithelium

To - Mucin-Secreting Columnar Epithelium

Question 4

Where, other than in the Oesophageal Mucosa in Barrett’s Oesophagus, can Mucin-Secreting Columnar Epithelium be found?

Answer 4

These Cells can be seen in the Epithelium of the Cells which line the Stomach

Question 5

What is the Purpose of the Metaplasia?

Answer 5

To try and prevent the Oesophagus from further injury

Question 6

What are the Clinical Signs of Barrett’s Oesophagus?

Answer 6

1. Increased Oesophageal pH

2. Oesophageal Mucosal Metaplasia

Question 7

What symptoms would a patient with Barrett’s Oesophagus present with?

Answer 7

1. Heart Burn
2. Regurgitation
3. Cough
4. Water-Brash
5. Sleep Disturbances

Question 8

What causes the feeling of “Heartburn”?

Answer 8

The actions of Gastric Acid and Pepsin on the Oesophageal Mucosa

Question 9

What causes the “Regurgitation”?

Answer 9

The Weakened Lower Oesophageal Sphincter

Question 10

When would “Rregurgitation” occur most often in Barrett’s Oesophagus?

Answer 10

When lying flat

Question 11

What causes the “Cough”?

Answer 11

Due to the Body’s natural response to any potential Aspiration of Gastric Contents

Question 12

What is “Water Brash”?

Answer 12

The Over-Production of Saliva in the Oral Cavity

Question 13

Why does “Water Brash” occur?

Answer 13

It is an action of the Mouth to try and Dilute and Counteract the effect the Gastric Contents are having on the Oesophageal Mucosa

Question 14

What investigations are Required in Barrett’s Oesophagus?

Answer 14

1. Upper G.I. Endoscopy with Biopsy

2. 24-hour pH monitoring with Manometry

Question 15

What is the purpose of the Upper G.I. Endoscopy and Biopsy?

Answer 15

1. To assess the extent of Metaplasia in the Oesophagus

2. To look for signs of Dysplasia

Question 16

What is the 24-hour pH with Manometry measuring?

Answer 16

1. The average pH in the Oesophagus over a 24-hour period

2. The Internal Pressure within the Oesophagus over a 24-hour period

Question 17

What is the Treatment Options for Barrett’s Oesophagus?

1st line to last option

Answer 17

1. Endoscopic Mucosal Resection
2. Radio-Frequency Ablation
3. Oesophagectomy

Question 18

What is the Major Risk of Barrett’s Oesophagus?

Answer 18

The the Metaplasia continues into Dysplasia - Causing Oesophageal Cancer

Question 19

What is an Endoscopic Mucosal Resection?

Answer 19

The Endoscopic removal of the effected tissue

Question 20

What is a Radio-Frequency Ablation?

Answer 20

The passing of an Electrical Current through the effected tissue, killing it, so no more Metaplasia can occur

Question 21

What is an Oesophagectomy?

Answer 21

The Surgical Removal of the Oesophagus, and the Stomach is stretched to reach the Upper Oesophageal Sphincter

Question 22

What is the Mortality rate for an Oesophagectomy?

Answer 22

10%, so this is rarely done

Question 23

Does Barrett’s Oesophagus occur in the Proximal or Distal Oesophagus?

Answer 23

Distal

Question 24

Is Barrett’s Oesophagus more common in Males or Females?

Answer 24

Males