Barrett's Oesophagus

Question 1

What is Barrett’s oesophagus?

Answer 1

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).

Question 2

What is the prevalence of Barrett’s oesophagus among patients with reflux symptoms?

Answer 2

Approximately 2.3% of patients with reflux symptoms have Barrett’s oesophagus.

Question 3

Why is Barrett’s oesophagus considered a pre-malignant condition?

Answer 3

It increases the risk of developing oesophageal adenocarcinoma.

Question 4

What is the primary cause of Barrett’s oesophagus?

Answer 4

Chronic damage from gastro-oesophageal reflux disease (GORD).

Question 5

What are the risk factors for developing Barrett’s oesophagus?

Answer 5

GORD, acid-bile reflux, increasing age, obesity, white ethnicity, male sex, and genetic predisposition.

Question 6

What are common symptoms associated with Barrett’s oesophagus?

Answer 6

Often asymptomatic, but may include heartburn, regurgitation, dysphagia, haematemesis, odynophagia, chest pain, and cough.

Question 7

How is Barrett’s oesophagus diagnosed?

Answer 7

Through upper gastrointestinal endoscopy with biopsy, identifying ‘salmon-coloured’ epithelium above the gastro-oesophageal junction.

Question 8

What is the Prague C & M classification used for?

Answer 8

Assessing the circumferential (C) and maximal (M) extent of Barrett’s oesophagus during endoscopy.

Question 9

What is the first-line medical treatment for Barrett’s oesophagus?

Answer 9

High-dose proton pump inhibitors (PPIs) to manage acid reflux.

Question 10

What endoscopic treatment is considered for low-grade dysplasia in Barrett’s oesophagus?

Answer 10

Radiofrequency ablation.

Question 11

What is the recommended management for high-grade dysplasia in Barrett’s oesophagus?

Answer 11

Endoscopic resection of visible lesions, with or without radiofrequency ablation.

Question 12

How often should surveillance endoscopy be performed for Barrett’s oesophagus without dysplasia?

Answer 12

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.

Question 13

What is the annual incidence of oesophageal adenocarcinoma in patients with Barrett’s oesophagus?

Answer 13

Approximately 0.33% per year.

Question 14

What lifestyle modifications can help manage Barrett’s oesophagus?

Answer 14

Weight loss, elevating the head of the bed, avoiding meals before bedtime, and reducing intake of alcohol, caffeine, and fatty foods.

Question 15

What is the role of anti-reflux surgery in Barrett’s oesophagus?

Answer 15

Considered in selected patients, especially those with refractory symptoms despite optimal medical therapy.

Question 16

What histological finding confirms the diagnosis of Barrett’s oesophagus?

Answer 16

The presence of intestinal metaplasia with goblet cells in oesophageal biopsies.

Question 17

What is the significance of ‘salmon-coloured’ mucosa seen during endoscopy?

Answer 17

It indicates the presence of columnar-lined oesophagus, suggestive of Barrett’s oesophagus.

Question 18

What are potential complications of Barrett’s oesophagus besides adenocarcinoma?

Answer 18

Oesophageal strictures and ulcers.

Question 19

How does obesity contribute to the development of Barrett’s oesophagus?

Answer 19

Increased intra-abdominal pressure promotes gastro-oesophageal reflux, leading to chronic oesophageal damage.

Question 20

Why is male sex considered a risk factor for Barrett’s oesophagus?

Answer 20

Men have a higher prevalence of Barrett’s oesophagus and a greater risk of progression to oesophageal adenocarcinoma.

Question 21

What is the purpose of surveillance in patients with Barrett’s oesophagus?

Answer 21

To detect dysplasia or early cancer, allowing for timely intervention.

Question 22

How does smoking influence the risk of Barrett’s oesophagus?

Answer 22

Smoking increases the risk of progression from Barrett’s oesophagus to oesophageal adenocarcinoma.

Question 23

What is the typical appearance of Barrett’s oesophagus on endoscopy?

Answer 23

A visible segment of ‘salmon-coloured’ mucosa extending above the gastro-oesophageal junction.

Question 24

What is the recommended follow-up for patients with Barrett’s oesophagus and confirmed low-grade dysplasia?

Answer 24

Consider endoscopic ablation therapy or increased surveillance frequency, typically every 6-12 months.

Question 25

How does chronic gastro-oesophageal reflux lead to Barrett’s oesophagus?

Answer 25

Persistent acid exposure causes metaplasia, replacing squamous epithelium with columnar epithelium.