barrett's oesophagus

Question 1

definition

Answer 1

Barrett’s oesophagus is a change in the normal squamous epithelium of the oesophagus to specialised intestinal metaplasia (usually columnar cells). This is associated with gastro-oesophageal reflux, even if the reflux is asymptomatic. Essential to the diagnosis is histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells. Beyond gastro-oesophageal reflux-related symptoms, the main concern is the increased risk of adenocarcinoma of the oesophagus.

Question 2

symptoms/signs

Answer 2

heartburn

regurgitation

Question 3

risk factors

Answer 3

acid-bile reflux or GORD 
increased age
white ethnicity
male sex
obesity
smoking
family history of oesophageal adenocarcinoma

Question 4

investigations

Answer 4

1st investigations:

• upper GI endoscopy with biopsy
• barium oesophagogram

Question 5

treatment

Answer 5

non-dysplastic:
1. PPI (omeprazole) + surveillance
++ radiofrequency ablation
2. anti-reflux surgery + surveillance (if don’t want to use PPI anymore)

low grade dysplasia:
1. radiofrequency ablation +/- endoscopic mucosal resection

high grade dysplasia:
1. radiofrequency ablation +/- endoscopic mucosal resection
++ PPI
2. oesophagectomy

Question 6

complications

Answer 6

• dysplasia and adenocarcinoma
• oesophageal stricture
• quality of life deficit