Barrett's Oesophagus Flashcards
What is Barrett’s Oesophagus?
Barrett’s oesophagus = metaplasia change of stratified squamous oesophageal epithelial cells to simple columnar intestinal cells with goblet cells
What is the aetiology of Barrett’s oesophagus?
Primary factor is GORD/chronic oesophagitis – but also combined acid and bile reflux
Highest level of oesophageal bile in Barrett’s oesophagus patients
Prolonged refluxate exposure can erode the mucosa, promote inflammatory cell infiltrate and cause epithelial necrosis
Recommended to screen for Barrett’s in patients with symptoms >5 years
Two types Long-segment Barrett’s oesophagus (>3cm) Longer duration of reflux symptoms Low LOS pressure Combined supine/erect pattern of reflux Less sensitive to acid exposure
Short-segment Barrett’s oesophagus (<3cm) Shorter duration of reflux symptoms Normal LOS pressure Erect pattern of reflux More sensitive to acid exposure
What are the risk factors for Barrett’s oesophagus?
GORD - Barrett’s oesophagus does not develop in the absence of reflux
All risk factors associated with GORD Male - 2x increased risk White >50 y/o FHx Central obesity
What is the epidemiology of Barrett’s oesophagus?
1.6% prevalence
Twice as common in those with reflux symptoms
Rare in children
Increasing prevalence with age
Mean age at time of diagnosis is 55 years
Increased prevalence in white people and men
What are the symptoms of Barrett’s oesophagus?
Heartburn Regurgitation Dysphagia Chest pain Laryngitis Cough Nausea Hoarse/sore throat
What are the signs of Barrett’s oesophagus?
Regurgitation on swallow
What are appropriate investigations for Barrett’s oesophagus?
Upper GI contrast radiography = not diagnostic
Hiatal hernia
GORD reflux signs
Evaluate for mass lesion or stricture before endoscopy
Upper GI endoscopy with biopsy = diagnostic test
Biopsy showing areas of columnar-lined oesophagus – tongue shaped
Violaceous epithelium proximal to GOJ
Areas of ulceration, narrowing and nodularity should be targeted for biopsy
Screening
For people with risk factors (above)
High resolution white light endoscopy
What is the management of Barrett’s oesophagus?
GORD therapy
PPIs (e.g. omeprazole 20mg daily)
Endoscopic screening (high definition white light)
Every 2 years
Systematic 4-quadrant biopsies at 2cm intervals plus areas of abnormality
Non-dysplastic: every 5 years <3cm
Non-dysplastic: every 3 years >3cm
Ablative therapy
HIGH GRADE DYSPLASIA
Aim for re-epithelisation into squamous cells
Resection (endoscopic mucosal)/oesophagectomy
NODULES + PPIs to prevent recurrence
What are possible complications of Barrett’s Oesophagus?
Adenocarcinoma - Average interval of around 4 years
Oesophageal stricture -Treated mainly with endoscopic dilation but can be surgically resected
Deficit in quality of life
What is the prognosis of Barrett’s Oesophagus?
Risk of cancer - Usually found around 4 years after diagnosis (0.5% risk per year)
30 fold increased risk compared to general population
Screening
Every 2 years
Oesophagectomy indicated if carcinoma detected
Generally, find early-stage lesions with good prognosis (85% 5 year survival)
