Barrett's Oesophagus Flashcards
What is Barrett’s oesophagus?
Barrett’s oesophagus is a condition where there is an abnormal change in the cells lining the lower portion of the oesophagus due to chronic damage from gastro-oesophageal reflux disease (GORD).
What is the prevalence of Barrett’s oesophagus among patients with reflux symptoms?
Approximately 2.3% of patients with reflux symptoms have Barrett’s oesophagus.
Why is Barrett’s oesophagus considered a pre-malignant condition?
It increases the risk of developing oesophageal adenocarcinoma.
What is the primary cause of Barrett’s oesophagus?
Chronic damage from gastro-oesophageal reflux disease (GORD).
What are the risk factors for developing Barrett’s oesophagus?
GORD, acid-bile reflux, increasing age, obesity, white ethnicity, male sex, and genetic predisposition.
What are common symptoms associated with Barrett’s oesophagus?
Often asymptomatic, but may include heartburn, regurgitation, dysphagia, haematemesis, odynophagia, chest pain, and cough.
How is Barrett’s oesophagus diagnosed?
Through upper gastrointestinal endoscopy with biopsy, identifying ‘salmon-coloured’ epithelium above the gastro-oesophageal junction.
What is the Prague C & M classification used for?
Assessing the circumferential (C) and maximal (M) extent of Barrett’s oesophagus during endoscopy.
What is the first-line medical treatment for Barrett’s oesophagus?
High-dose proton pump inhibitors (PPIs) to manage acid reflux.
What endoscopic treatment is considered for low-grade dysplasia in Barrett’s oesophagus?
Radiofrequency ablation.
What is the recommended management for high-grade dysplasia in Barrett’s oesophagus?
Endoscopic resection of visible lesions, with or without radiofrequency ablation.
How often should surveillance endoscopy be performed for Barrett’s oesophagus without dysplasia?
Every 3-5 years if the segment is less than 3 cm with intestinal metaplasia; every 2-3 years if the segment is greater than 3 cm.
What is the annual incidence of oesophageal adenocarcinoma in patients with Barrett’s oesophagus?
Approximately 0.33% per year.
What lifestyle modifications can help manage Barrett’s oesophagus?
Weight loss, elevating the head of the bed, avoiding meals before bedtime, and reducing intake of alcohol, caffeine, and fatty foods.
What is the role of anti-reflux surgery in Barrett’s oesophagus?
Considered in selected patients, especially those with refractory symptoms despite optimal medical therapy.
What histological finding confirms the diagnosis of Barrett’s oesophagus?
The presence of intestinal metaplasia with goblet cells in oesophageal biopsies.
What is the significance of ‘salmon-coloured’ mucosa seen during endoscopy?
It indicates the presence of columnar-lined oesophagus, suggestive of Barrett’s oesophagus.
What are potential complications of Barrett’s oesophagus besides adenocarcinoma?
Oesophageal strictures and ulcers.
How does obesity contribute to the development of Barrett’s oesophagus?
Increased intra-abdominal pressure promotes gastro-oesophageal reflux, leading to chronic oesophageal damage.
Why is male sex considered a risk factor for Barrett’s oesophagus?
Men have a higher prevalence of Barrett’s oesophagus and a greater risk of progression to oesophageal adenocarcinoma.
What is the purpose of surveillance in patients with Barrett’s oesophagus?
To detect dysplasia or early cancer, allowing for timely intervention.
How does smoking influence the risk of Barrett’s oesophagus?
Smoking increases the risk of progression from Barrett’s oesophagus to oesophageal adenocarcinoma.
What is the typical appearance of Barrett’s oesophagus on endoscopy?
A visible segment of ‘salmon-coloured’ mucosa extending above the gastro-oesophageal junction.
What is the recommended follow-up for patients with Barrett’s oesophagus and confirmed low-grade dysplasia?
Consider endoscopic ablation therapy or increased surveillance frequency, typically every 6-12 months.
How does chronic gastro-oesophageal reflux lead to Barrett’s oesophagus?
Persistent acid exposure causes metaplasia, replacing squamous epithelium with columnar epithelium.
