Barrett's Oesophagus

Question 1

Define Barrett’s oesophagus

Answer 1

Metaplastic change arising in the lower oesophageal mucosa from oesophageal (stratified
squamous) epithelium to intestinal (simple columnar) epithelium secondary to prolonged
acid reflux

Question 2

What are the causes/risk factors of Barrett’s oesophagus?

Answer 2

Caused by GORD
• Central obesity
• Age
• White ethnicity
• Male
• Family history
• Smoking

Question 3

What are the signs and symptoms of Barrett’s esophagus?

Answer 3

Symptoms
• Heartburn
• Regurgitation
• Dysphagia

Signs
Nil of note

Question 4

What investigations are carried out for Barrett’s oesophagus?

Answer 4

Endoscopy with biopsy:
• OGD
• histological specimen must be obtained. Barrett’s Oesophagus is a pathological diagnosis.
• The endoscopic appearance of Barrett’s oesophagus is violaceous epithelium proximal to the gastro-oesophageal junction. The Z line is migrated cephalad.

Question 5

What is the management for Barrett’s oesophagus?

Answer 5

Conservative
• Smoking cessation
• weight loss
• low-fat foods

Non-dysplastic Barrett’s Oesophagus:
• PPI e.g. omeprazole, 20 mg/day P.O
• Endoscopic Radiofrequency Ablation –RFA
• Surveillance every 2 years, with biopsies of each of the 4 quadrants of the CLO

Barrett’s Oesophagus with Low-Grade Dysplasia: these are usually flat and non-nodular macroscopically
• High-dose PPIs
• Radiofrequency Ablation
• Endoscopic Mucosal Resection: If nodular lesions are present (but LGD)
• Surveillance within 6 months

Barrett’s Oesophagus with High-Grade Dysplasia: these are often nodular macroscopically
• High-dose PPIs
• Radiofrequency Ablation
• Endoscopic Mucosal Resection: If nodular lesions are present –allows for more accurate histology
• Surveillance within 3 months
• Oesophagectomy: a definitive treatment option, which enables identification of any occult malignancy.

Question 6

What are the complications of Barrett’s oesophagus?

Answer 6

• Dysplasia
• Adenocarcinoma
• Oesophageal Carcinoma
• Oesophageal Stricture