Barrets Oesophagus

Question 1

What is Barrett’s oesophagus?

Answer 1

Metaplasia of the oesophageal epithelium from stratified squamous to simple columnar epithelium

Question 2

What is the definition of metaplasia

Answer 2

The abnormal reversible change of cells from one cell type to another

Question 3

What is the pathophysiology of Barrett’s oesophagus

Answer 3

Vast majority are caused by GORD. When acid leaks into the oesophagus, it irritates the mucosal lining of the oesophagus and damages it. This results in metaplastic transformation which in turn increases the chance for dysplastic growth

Question 4

What are the risk factors of developing Barrett’s oesophagus

Answer 4

Caucasian
Male 
50+ years 
Smoking
Obesity 
Hiatus hernia 
FH

Question 5

What are the clincal features of Barrett’s oesophagus

Answer 5

History of GORD
Retrosternal pain
Chronic cough
Red flag sx => weight loss, dysphagia, loss of appetite

Question 6

What investigation is carried out to diagnose Barrett’s oesophagus

Answer 6

OGD - oesophagus will appear red and velvety

Biopsy should be taken and sent to histology - refer to teach me surgery picture

Question 7

How do you treat Barrett’s oesophagus

Answer 7

High dose PPI BD
Stop any medication that affects the stomach eg - NSAIDs
Lifestyle advice - stop smoking, drinking etc

Question 8

How often should someone with Barrett’s oesophagus with no dysplasia undergo endoscopy?

Answer 8

Every 2-5 years

Question 9

How often should someone with Barrett’s oesophagus with low grade dysplasia undergo endoscopy?

Answer 9

Every 6 months

Question 10

How often should someone with Barrett’s oesophagus with high grade dysplasia undergo endoscopy?

Answer 10

Every 3 months

Question 11

How do you treat high grade dysplasia

Answer 11

EMR - endoscopic mucosal resection

ESD - endoscopic submucosal dissection