barrett's oesophagus

Question 1

histopatholigcal examination will show

Answer 1

columnar epithelium (like gastric or intestinal epithelium) instead of the normal squamous epithelium

Question 2

define barretts oesophagus

Answer 2

premalignant condition
intestinal metaplasia of the oesophageal mucosa induced by chronic reflux

Question 3

risk factors for berretts oesophagus

Answer 3

male sex
european descent
age >50
obesity
symptoms >5 years

Question 4

pathophysiology of barretts

Answer 4

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

Question 5

the Z line

Answer 5

the physical transformation zone between between squamous and columnar epithelium
shifted upwards in barretts oesophagus

Question 6

complications

Answer 6

oesophageal adenocaarcinoma

Question 7

management

Answer 7

PPI - continue as long term maintenance therpay if symptomatic
if barrets is diagnosed on endoscopy, refer to a gastroenterologist for discussion about surveilence
consider anti reflux surgery or resection of the segment based on a specialists evaluation

Question 8

endoscopy for barretts oesophagus

Answer 8

four quadrant biopsies at every 2cm of the suspicious area (salmon coloured mucosa)
if high grade dysplasia - endoscopic treatment of mucosal irregularities eg. radiofrequency ablation

Question 9

what might surveilence look like for these patients

Answer 9

surveillence is the standard of care
regular biopsies to detect dysplsia or early mlignancy