Barrett's Oesophagus

Question 1

def

Answer 1

change in normal squamous epithelium of the oesophagus to specialised intestinal metaplasia
associated with GORD
associated with increased risk of adenocarcinoma of the oesophagus

for diagnosis, biopsy showing columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells

Question 2

aetiology

Answer 2

primary aetiological factor is GORD
acid & bile reflux causes oesophageal mucosal injury
overtime may cause normal squamous epithelium to change into columnar lined epithelium with or without intestinal metaplasia & with goblet cells

Question 3

epi

Answer 3

increasing incidence
around 1-2% of the general population
frequency of oesophageal adenocarcinoma has increased, this may be linked to increased incidence of GORD
increases with age
more common in caucasian males

Question 4

risk factors

Answer 4

GORD
increased age
white males

Question 5

history & examination

Answer 5

presence of risk factors (GORD, increased age, white males)
heartburn (symptom of GORD)
regurgitation (symptom of GORD)
dysphagia
chest pain (atypical GORD symptom)

Question 6

investigations

Answer 6

1 upper GI contrast radiography
-hiatal hernia & reflux
2 upper GI endoscopy with biopsy
-abnormal epithelium characteristic of Barrett’s oesophagus

Question 7

management

Answer 7

if no evidence of dysplasia:
-regular endoscopic surveillance
for high grade dysplasia:
-oesophagectomy
-endoscopic treatments such as endoscopic mucosal resection or ablation

NSAIDS such as aspirin have been shown to prevent oesophageal cancer in people with barrett’s oesophagus

Question 8

complications

Answer 8

1 reduce QOL
-oesophageal-related symptoms
-depression, anxiety, stress
2 oesophageal stricture
-due to the acid reflux
3 adenocarcinoma
-average interval between cancer & barrett's oesophagus is 4yrs
-incidence is 0.25-0.5% per year

Question 9

prognosis

Answer 9

adenocarcinomas found while screening for barrett’s oesophagus are early lesions and have a good prognosis (>85% 5yr survival)