Barrett's Esophagus Flashcards
What is Barrett’s esophagus
Metaplastic columnar epithelium with gastric/intestinal features replacing normal stratified squamous epithelium
US guidelines - biopsy confirmation
UK guidelines - Histological confirmation
What is the epidemiology of Barrett’s?
1.3% in Asian
>50 Y/O
Males
10-15% of patients have esophagitis or longstanding GERD
What are the risk factors for GERD
- Long term acid reflux
- Age
- Males, smoking, caucasian, family history
- Hiatal hernia
What is the pathophysiology of Barrett’s esophagus?
Intestinal metaplasia where the squamous mucosa is converted into mucus secreting columnar epithelium with goblet cells
Gatro-esophageal junction is the proximal end of the gastric longitudinal mucosal folds/distal end of esophageal palisading vessels
What is the clinical presentation of Barrett’s?
Asymptomatic but might present with GERD
Long standing gastric reflux reported dysphagia, heartburn and bleeindg
What are the complications of Barrett’s?
- 4bs of ulcers - Bleed, burrow, burst, block
- Ulcers penetrate metaplastic epithelium the same way as gastric ulcers
- Scarring and strictures
- Increased risk of dysplasia and adenocarcinoma
Divided between
Non dysplastic - 033%/year
Low grade dysplasia - 0.7%/year
High grade dysplasia - 7%/year
High grade dysplasia requires intervention
What are the investigations for Barrett’s?
- Endoscopy and histology
2. OGD + Biopsy
What are the endoscopic results of BE?
Endoscopy and histology
Normal - Pale-pink and smooth, SCJ and Z line are the same
Barrett’s - Extension of salmon coloured mucosa into esophagus >1cm proximal to GEJ (SCJ is proximal to the GEJ)
Mucosa has histological confirmation of goblet cells from 8 random biopsies, 4 quadrant biopsies every 2cm
What is the function of OGD+ biopsy in Barrett’s?
OGD + biopsy defines short (<3cm) vs long (≥3cm) segment of Barrett’s.
What are the indications for OGD+biopsy?
Risk factors
- Age >50
- Male
- Caucasian.
- Obesity
- Smoking
- GERD
- Hiatal Hernia
- Family history
What is the prague c&M criteria
Measures the depth of barrett’s during OGD withdrawal (must be careful that the OGD is straight)
The “C” is determined by measuring the distance from the GE junction to the highest location where metaplasia is present around the entire circumference of the esophagus.
The “M” is the distance from the GE junction to the highest location of metaplasia.
The higher the Prague C&M numbers (eg. C3 M5), the more severe the Barrett’s esophagus and the higher the risk of developing cancer.
What is the biopsy results of the Barrett’s region?
1. Gastric cardia-type mucosa Cardiac mucosa (also called cardia-type or junctional mucosa), which has a foveolar (pitted) surface and glands that are lined exclusively by mucus-secreting cells; these cells resemble normal gastric foveolar cells.
- Atrophic gastric fundic-type mucosa
Atrophic gastric fundic-type epithelium (also called oxyntocardiac epithelium), which has a foveolar surface lined by mucus-secreting cells, and a deeper glandular layer that contains chief and parietal cells; these cells resemble those in the gastric fundus.
- Specialised intestinal metaplasia
(a number of columnar cell types including goblet cells, gastric foveolar-type cells, small intestinal-like cells, and colonic-like columnar cells)
What is the overview of management of Barrett’s esophagus?
- Treat reflux
- Chemoprevention
- Endoscopic surveillance
- Resection for high grade dysplasia
How is underlying reflux treated?
- Lifestyle changes
- Acidsuppresion (PPIs)
- Surgery (Similiar to GERD)
However elimination may halt progression, heal ulcers, prevent strictures but it does not reduce risk of cancer and requires endoscopic surveillance
How is chemoprevention administered?
High dose PPE + Aspirin (only if patients are not on NSAIDS)
long term therapy to see results (8-9years and above)
