Barrett's Oesophagus

Question 1

Definition

Answer 1

Metaplasia of the lower oesophageal mucosa (stratified squamous to columnar epithelium with goblet cells)

Question 2

Epidemiology

Answer 2

Approx 10% of patients who experience GORD have Barrett’s oesophagus
Middle age ~ 55 years
Male = 7 times more common in males
Caucasian

Question 3

Risk factors

Answer 3

Smoking
Obesity

Question 4

Aetiology

Answer 4

GORD
Always involves hiatus hernia

Question 5

Pathophysiology

Answer 5

Adaptive response to acid to protect oesophageal wall = Transformation of one differentiated cell type to another differentiated cell type (METAPLASIA) of the lower oesophageal lining from stratified squamous epithelium to mucous secreting columnar epithelium with goblet cells.
It occurs in response to acidic stress and is therefore associated with GORD.
Predisposes to subsequent dysplasia and oesophageal adenocarcinoma = associated with a 30-fold increased

Question 6

Signs and symptoms

Answer 6

No specific symptoms or signs - typically diagnosed on endoscopy for upper GI symptoms
Symptoms related to GORD:
- Burning retrosternal chest pain = heart burn
- Indigestion
- Regurgitation
- Hoarse voice
- Cough: reflux-induced

Question 7

Diagnosis

Answer 7

FIRST LINE: Barium Oesophagogram
GOLD STANDARD: Endoscopy with biopsy

Question 8

Treatment

Answer 8

Treatment of underlying reflux:
- Lifestyle changes: weight loss, smoking cessation, alcohol abstinence
- PPI
Non-dysplastic BO: repeat surveillance endoscopy every 5 years
Low grade BO: repeat endoscopy every 6 months, if there is no longer any dysplasia over 2 consistent endoscopies = Px followed up as non-dysplastic
High grade BO:
- radiofrequency ablation = typically for flat lesions
- endoscopic mucosal resection: typically for raised lesions
Adenocarcinoma: Oesophagectomy