Barrett's Oesophagus Flashcards
What is Barrett’s oesophagus?
Barrett’s oesophagus refers to metaplasia of the oesophageal epithelial lining, whereby normal stratified squamous epithelium is replaced by simple columnar epithelium.
How common is Barrett’s oesophagus?
The prevalence ranges from 0.5-2% in the Western world. Around 10% of patients with gastro-oesophageal reflux disease (GORD) will have already developed Barrett’s oesophagus by the time they seek medical attention.
What is metaplasia?
Metaplasia is the abnormal reversible change of one cell type to another.
What metaplasia occurs in Barrett’s oesophagus?
In Barrett’s oesophagus, the normal stratified squamous layer of the oesophagus is replaced by simple columnar (glandular) epithelium (as present in the stomach).
Why is Barrett’s oesophagus associated with GORD?
The vast majority of cases are caused by chronic gastro-oesophageal reflux disease. The epithelium of the oesophagus becomes damaged by the reflux of gastric contents, resulting in a metaplastic transformation. This in turn increases the risk of developing dysplastic and neoplastic changes.
Which part of the oesophagus is commonly affected?
The distal oesophagus is most commonly affected.
Briefly describe what is shown on the image
Barrett’s oesophagus at the GOJ, showing gastric acinar metaplasia on the left and oesophageal stratified squamous epithelium on the right.
What are the risk factors for Barrett’s oesophagus?
The risk factors for developing Barrett’s oesophagus include caucasian, male, >50yrs age, smoking, obesity, presence of hiatus hernia, and a positive family history of Barrett’s oesophagus.
What are the clinical features of Barrett’s oesophagus?
The typical presentation of Barrett’s oesophagus is a history of chronic gastro-oesophageal reflux disease. Features include retrosternal chest pain, excessive belching, odynophagia, chronic cough and hoarseness.
Examination will be unremarkable in cases of solely Barrett’s oesophagus with no further complications.
What red flags should be asked about in Barrett’s oesophagus?
Remember to check for red flag symptoms of potential malignancy, including dysphagia, weight loss, early satiety, malaise, loss of appetite, or worsening dyspepsia despite PPI treatment.
What investigations should be ordered for Barrett’s oesophagus?
Barrett’s oesophagus is a histological diagnosis. Patients who undergo OGD for chronic or resistant GORD (or to exclude malignancy) should have a biopsy taken of the oesophageal epithelium and sent for histological analysis.
How does Barrett’s oesophagus present at the OGD?
At OGD, the oesophagus appears red and velvety in cases of Barrett’s oesophagus, with some preserved pale squamous islands.
Briefly describe the medical management of Barrett’s oesophagus
All patients with Barrett’s oesophagus should be commenced on a proton-pump inhibitor (typically high dose and twice daily).
Any medication that impacts the stomach protective barriers (such as NSAIDs) should be stopped. In addition, the patient should be provided with lifestyle advice to reduce the acidic stimulus on the squamous cells.
The major risk of Barrett’s oesophagus is progression to adenocarcinoma. Therefore, all patients with confirmed Barrett’s oesophagus must undergo regular endoscopy. The frequency of this depends on the degree of dysplasia identified by the biopsies (if any).
How often do patients with Barrett’s oesophagus have to undergo a endoscopy?
Note: no dysplasia, low grade dysplasia and high grade dysplasia
No dysplasia: every 2-5 years
Low grade dysplasia: every 6 months
High grade dysplasia: every 3 months
What is the major risk of Barrett’s oesophagus?
The major risk of Barrett’s oesophagus is progression to adenocarcinoma.
