Barrett’s Oesophagus

Question 1

Barrett’s Oesophagus

Answer 1

Metaplasia of the oesophageal epithelial lining

Normal stratified squamous epithelium is replaced by simple columnar epithelium

Question 2

Risk factors

Answer 2

GORD
Caucasian 
Male
Smoking 
50 + yo
Hiatus hernia 
FHx

Question 3

Investigations

Answer 3

OGD and biopsy

Question 4

Clinical Features

Answer 4

Chest pain
Excessive belching
Odynophagia
Chronic cough
Hoarseness

Question 5

Red flag symptoms

Answer 5

Dysphagia
Early satiety
FLAWS
Worsening dyspepsia despite PPI treatment

Question 6

Conservative Mx

Answer 6

Stop smoking
Smaller meals
Reduce alcohol and spicy food intake

Question 7

Medical management

Answer 7

PPI

Stop NSAIDs

Question 8

Surveillance

Answer 8

Regular endoscopy

No dysplasia - every 2 - 5 years

Low grade dysplasia - every 6 months

High grade dysplasia - every 3 months

Question 9

High grade dysplasia

Answer 9

Resected with endoscopic mucosal resection (EMR)

or

endoscopic submucosal dissection (ESD)

Question 10

Squamous cell carcinoma

Answer 10

Found in upper 2/3rds of oesophagus

RF:

• smoking
• alcohol

Mx:
- chemotherapy

Question 11

Mx of adenocarcinoma

Answer 11

Neoadjuvant chemotherapy

Oesophageal resection

Question 12

Complications of oesophageal surgery

Answer 12

Anastomotic leak - re - operation

Pneumonia - as lung deflated during surgery and pain

Death