Barrett’s Oesophagus

Question 1

What is the definition of Barrett’s oesophagus?

Answer 1

Intestinal metaplasia (transformation of the epithelium) of oesophageal mucosa induced by chronic reflux. It is a premalignant change that requires close surveillance

Question 2

what are the historical findings for Barrett’s oesophagus?

Answer 2

Columnar epithelium instead if normal squamous epithelium

Question 3

What is the incidence in patients with GERD?

Answer 3

Up to 15%

Question 4

What are the risk factors for Barrett’s oesophagus?

Answer 4

Male sex
European descent
Age >50
Obesity
Symptoms >5 years

Question 5

what is the pathophysiology behind Barrett’s oesophagus?

Answer 5

Reflux oesophagitis -> stomach acid damages mucosa of distal oesophagus -> non keratinised stratified squamous epithelium is replaced by non ciliated columnar epithelium sand goblet cells

Question 6

What are the complications of Barrett’s oesophagus?

Answer 6

Oesophageal adenocarcinoma

Question 7

What is the management and surveillance for Barrett’s oesophagus?

Answer 7

PPI therapy - consider i of asymptomatic and continue maintenance therapy long term if symptomatic
Endoscopy
Anti reflux surgery

Question 8

What is the purpose of endoscopy for Barrett’s oesophagus?

Answer 8

If no dysplasia - repeat every 3-5 years
If indefinite for dysplasia - repeat endoscopy with biopsies every 6-12 months with biopsies every 1cm
If high grade dysplasia - endoscopic treatment off mucosal irregularities eg radiofrequency ablation

Question 9

How do you diagnose barrett’s oesophagus?

Answer 9

Endoscopy needed to confirm the abnormal oesophageal lining
Biopsies are needed for a positive diagni=osis

Question 10

What are the findings in an endoscopy for Barrett’s oesophagus?

Answer 10

Upper endoscopy - normally lining appears pale and glossy, in Barrett’s oesophagus it appears pink rot red or velvety.

Question 11

Which foods can make the reflux worse?

Answer 11

Chocolate
Coffee and tea
Peppermint
Alcohol
Fatty foods
Acidic juices
Carbonated drinks

Question 12

Which lifestyle behaviours can make the reflux worse?

Answer 12

Eating meals just before going to bed
Lying down after eating meals
Eating very large meals

Question 13

What are the clinical features of Barrett’s oesophagus?

Answer 13

Typically asymptomatic
Most patients seen initially for symptoms of GERD - heart burn, regurgitation and Dysphagia