Barrett's Oesophagus Flashcards
What is Barrett’s oesophagus?
It is defined as a condition in which there is metaplasia of the lower oesophageal mucosa
It is a pre-malignant condition resulting in an increased risk of developing oesophageal adenocarcinoma
What epithelial transformation occurs in Barrett’s oesophagus?
Stratified squamous epithelium
TRANSFORMED INTO
Simple columnar epithelium
Describe the pathophysiology of Barrett’s oesophagus
Barrett’s oesophagus is most commonly associated with gastro-oesophageal reflux disease (GORD), which is defined as a condition in which gastric acid refluxes from the stomach through the lower oesophageal sphincter and irritates the lining of the oesophagus
This irritation over a prolonged period of time precipitates the metaplasia, in which oesophageal epithelium transforms into gastric/intestinal epithelium as a protective mechanism
What classification system is used in Barrett’s oesophagus?
Prague C & M Classification System
What does the ‘C’ in the ‘Prague C & M Classification System’ represent?
Circumferential Extent of Disease
This is defined as the distance from the gastro-oesophageal junction to the highest location metaplasia is present around the entire circumference of the oesophagus
What does the ‘M’ in the ‘Prague C & M Classification System’ represent?
Metaplasia Extent of Disease
It is defined as the distance from the gastro-oesophageal junction to the highest location of metaplasia
What does a high ‘Prague C & M Classification System’ score represent?
It demonstrates that the disease is more severe, and therefore there is a greater risk of malignant transformation
What are the six risk factors of Barrett’s oesophagus?
Gastro-Oesophageal Reflux Disease (GORD)
Male Gender
Older Age
White Ethnicity
Central Obesity
Smoking
What is the most common risk factor of Barrett’s oesophagus?
Gastro-Oesophageal Reflux Disease (GORD)
In general, how does Barrett’s oesophagus present?
Asymptomatically
However, individuals may experience the clinical features of GORD
What are the eight clinical features associated with Barrett’s oesophagus?
Heartburn
Acid Regurgitation
Dysphagia
Epigastric Pain
Abdominal Distension
Nocturnal Cough
Hoarse Voice
Weight Loss
What is the gold standard investigation used to diagnose Barrett’s oesophagus?
Endoscopy + Biopsy
What are the three histology features of Barrett’s oesophagus?
Salmon Columnar Epithelium Above Gastro-Oesophageal Junction (GOJ)
Goblet Cells
Brush Border
What is the minimum length of epithelial changes above the GOJ required for a diagnosis of Barrett’s oesophagus?
1cm
What are the four management options used to treat Barrett’s oesophagus?
Proton Pump Inhibitors
Endoscopic Surveillance + Biopsy
Radiofrequency Ablation (RFA)
Endoscopic Resection
Name two proton pump inhibitors (PPIs)
Omeprazole
Lansoprazole
When are PPIs used to manage Barrett’s oesophagus?
It is recommended in all Barrett’s oesophagus patients
How do PPIs manage Barrett’s oesophagus?
They inhibit gastric acid secretion by binding to the hydrogen potassium ATPase pump that resides on the luminal surface of the parietal cell membrane
This provides time for the damaged oesophageal tissue to heal, inducing regression of lesions and reducing the change of progression to dysplasia
When is endoscopic surveillance, with biopsies, used to manage Barrett’s oesophagus?
It is recommended in Barrett’s oesophagus with evidence of metaplasia, however no dysplasia features
How often do we conduct endoscopic surveillance in individuals with a metaplasia distance < 3cm?
3 - 5 years
How often do we conduct endoscopic surveillance in individuals with a metaplasia distance > 3cm?
2 - 3 years
What is radiofrequency ablation (RFA)?
It involves the application of heat generated by radio waves to ablate dysplastic oesophageal tissue
When is radiofrequency ablation (RFA) used to manage Barrett’s oesophagus?
It is the first line management option in Barrett’s oesophagus, with dysplasia features – particularly low grade dysplasia or high grade dysplasia with no visible lesions
What is endoscopic resection?
It involves endoscopic removal of dysplastic oesophageal tissue from the oesophagus
When is endoscopic resection used to manage Barrett’s oesophagus?
It is the first line management option in Barrett’s oesophagus, with dysplasia features –high grade dysplasia with visible lesions
