Barrett Esophagus

Question 1

Risk factors Barretts

Answer 1

• Males
• White
• > 40 - 50 YO
• Obesity
• CDX1 mRNA

Question 2

H. Pylori + GERD

Answer 2

• DEC parietal cell mass -> DEC acid -> DEC risk GERD

Question 3

Prague C+M Criteria

Answer 3

Standardized rules for severe Barrett’s
C: Circumferential extent: whole circle metaplasia
M: Maximum extent: Longest tongue of metalasia

Question 4

American College of GE Practice Screening Guidlines

Answer 4

• Patients with chronic GERD symptoms are those most likely to have Barrett’s esophagus and should undergo upper endoscopy
• Screening is best done with patients on PPIs, since erosions and ulcers can obscure BE and since active inflammation makes pathologic interpretation more difficult.

Question 5

Dysplasia + Cancer Risk

Answer 5

No Dysplasia: 2%
Low-grade: 7%
High grade: 22%

Question 6

Biopsy protocol for Surveillance Endoscopy in Barrett’sEsophagus

Answer 6

• Four-quadrant biopsies every 2-cm of the BE
• Additional biopsies of any mucosal abnormality
• In setting of high-grade dysplasia, biopsies taken every 1-cm.

Question 7

Barrets Tx:

Answer 7

• Esophagectomy: High mortality
• Endoscopic treatments: residual intestinal metaplasia can form beneath
• Intensive endoscopic surveillance