(!) Barett's Oesophagus

Question 1

Define Barett’s Oesophagus

Answer 1

Change in normal oesophageal epithelium (stratified squamous) to columnar intestinal epithelium and goblet cells (METAPLASIA)
Associated with acid reflux
Big risk of adenocarcinoma

Question 2

Aetiology and risk factors of Barett’s Oesophagus

Answer 2

Reflux (and possibly bile) going up the oesophagus causes damage. Stem cells proliferate to repair damage. cells from neck of oesophagus mucosa migrate to distal oesophagus-repair but wrong
Rarely genetic, but does have a component of genes

Risk factors
Any form of gastric reflux (GORD, peptic ulcer),
FHx of Barett’s Oesophagus, or oesophageal cancer
Age (Older-worse)
MALE
obesity
Smoking

Question 3

Epidiemology of Barett’s Oesophagus

Answer 3

between 0.5 and 2% of GENERAL population
oesophageal adenocarcnia x4 in men recently

about 9.9 in 1000 (super common)

Question 4

Signs and Sx of Barett’s Oesophagus

Answer 4

Reflux signs-
Heart burn (chest pain, after meals, burning sensation)
Regurgitation (feel it going up. bad taste in mouth)

Dysphagia-rarer-

GORD can present with cough, laryngitis (voice change), SOB/WHeeze (GORD related asthma)

Question 5

Investigation of Barett’s Oesophagus

Answer 5

OGD-1st line for suspected and only diagnosis tool (with associated histology)
Histology is the diagnostic tool

Barium Oesogram -before OGD to estimate size of lesion

Question 6

Management of Barett’s Oesophagus

Answer 6

Non dysplastic
PPI
+ surveillance -> OGD every 2 years

low grade-dysplasia
Radiofrequency ablation

high grade-(with nodules)
Endoscopic mucosal resection and radiofrequency ablation
+PPI
Oesophagectomy-remove it all lmao

Question 7

Complications of Barett’s Oesophagus

Answer 7

Dysplagia->Oesophageal adenocarcinoma (very hard to treat-high mortality rate-incidence increasing)

Oesophageal stricture-occurs a lot from reflux and needs surgery

bad QOL-not nice to have

Question 8

Prognosis of Barett’s Oesophagus

Answer 8

needs surveillance (OGD every 5-3 years depending on grade)
Generally, adenocarcinomas discovered while screening for Barrett's oesophagus are early-stage lesions and have good prognosis

PPI actually dont help much
(0.25% progress to cancer per year)
Anti-reflux can help in 25% of pt