Barrett's oesophagus

Question 1

What is barrett’s oespohagus and why i it concerning?

Answer 1

Barret’s oesophagus is a pre-malignant condition and increases the risk of oesophageal cancer by about 50 times compared to the general population. The risk of developing cancer is still relatively low (3 per 1000 per year) but increases significantly if dysplasia is present. Barrett’s metaplasia is a change from the normal squamous epithelium of the oesophagus to columnar epithelium, similar to that normally found in the stomach.

Question 2

Describe the pathophysiology behind epithelial changes in Barrett’s oesophagus

Answer 2

The oesophagus is normally lined by squamous epithelium and at the gastro-oesophageal junction, the epithelium normally changes to specialised glandular/columnar epithelium.
In Barrett’s, following a period of reflux, the epithelium in the distal oesophagus changes from squamous to columnar epithelium. This appears as ‘velvety tongues’ in the oesophagus when viewed endoscopically.

Question 3

How is barrett’s oesophagus diagnosed?

Answer 3

Biopsy of endoscopically visible columnarisation allows histological corroboration

Question 4

How is barrett’s oesophagus managed?

Answer 4

Pre-malignancy/ high grade:
• Oesophageal resection
• Eradicative mucosectomy
• Endoscopic targeted mucosectomy
• Mucosal ablation by epithelial lase
• Radiofrequency or photodynamic ablation

Low grade dysplasia
• Annual endoscopic surveillance