barrett's oesophagus Flashcards
histopatholigcal examination will show
columnar epithelium (like gastric or intestinal epithelium) instead of the normal squamous epithelium
define barretts oesophagus
intestinal metaplasia of the oesophageal mucosa induced by chronic reflux
risk factors for berretts oesophagus
male sex
european descent
age >50
obesity
symptoms >5 years
pathophysiology of barretts
reflux oesophagitis >
stomch acid damages mucosa of distal oesophagus >
non keratinised stratified squamous epithelium is replaced by nonciliated columnar epithelium and goblet cells (intestinal metaplasia, barrett metaplasia)
the stratified squamous epithelium of the lower oesophagus is not specialised to tolerate highly acidic stomach acid
the Z line
the physicla transformation zone between between squamous and columnar epithelium
shifted upwards in barretts oesophagus
complications
oesophageal adenocaarcinoma
management
PPI - continue as long term maintenance therpay if symptomatic
endoscopy
consider anti reflux surgery or resection of the segment based on a specialists evaluation
endoscopy for barretts oesophagus
four quadrant biopsies at every 2cm of the suspicious area (salmon coloured mucosa)
if high grade dysplasia - endoscopic treatment of mucosala irregularities eg. radiofrequency ablation