Barrett's Oesophagus

Question 1

Define:

Answer 1

Metaplasia of the lower oesophagus from stratified squamous to simple columnar usually due to an excess exposure to acid.

May lead to dysplasia and esophageal adenocarcinoma.

Question 2

Aetiology/Risk factors:

Answer 2

There is an reflux of acid in the oesophagus due to a defective lower oesophageal sphincter (causes are unknown)

Hiatus hernia makes GORD more likely

Question 3

Epidemiology:

Answer 3

1/10 adults experience heart burn everyday.

3-5% with GORD will develop Barrett’s.

Question 4

Symptoms:

Answer 4

Heartburn
Burning sensation when swallowing
Belching
Bloating
Water-brash (sour taste in mouth)
Nausea

Question 5

Signs:

Answer 5

Like symptoms

Question 6

Investigations:

Answer 6

OGD and biopsy to confirm squamous epithelium becomes columnar.

Question 7

Management:

Answer 7

High grade dysplasia - PPI + radio frequency ablation
Low grade dysplasia - PPI and endoscopic mucosal resection.

No dysplastic - PPI and surveillance.

Question 8

Complications:

Answer 8

Dysplasia

Oesophageal adenocarcinoma

Question 9

Prognosis:

Answer 9

Makes you 30-60 times more likely to develop an oesophageal adenocarcinoma compared to the normal population.

5-10% with barrett’s will develop adenocarcinoma in 10-20 years