Barrett's Oesophagus Flashcards
What is Barrett’s Oesophagus?
Metaplasia of the normal oesophageal epithelial lining, whereby normal stratified squamous epithelium is replaced by simple columnar epithelium (glandular tissue present in the stomach).
Define metaplasia
The abnormal reversible change of one cell type to another.
How common is Barrett’s Oesophagus?
Prevalence ranges from 0.5-2% in the Western world
10% of patients with GORD will have already developed Barrett’s oesophagus by the time they seek medical attention.
What is the most common cause of Barrett’s Oesophagus & What is the pathophysiology of this cause?
Most common cause is Chronic GORD.
The epithelium of the oesophagus becomes damaged by the reflux of gastric contents, resulting in a metaplastic transformation. This in turn increases the risk of developing dysplastic and neoplastic changes.
Which part of the oesophagus is most commonly affected?
Distal oesophagus
What are the risk factors for Barrett’s Oesophagus?
- Caucasian
- Male
- > 50 yrs age
- Smoking
- Obesity
- Presence of hiatus hernia
- Family history of Barrett’s oesophagus
What symptoms are typically seen in Barrett’s Oesophagus?
Symptoms of chronic gastro-oesophageal reflux disease:
- Retrosternal chest pain
- Excessive belching
- Odynophagia
- Chronic cough
- Hoarseness.
What red flag symptoms of potential malignancy should you check for?
- Dysphagia
- Weight loss
- Early satiety
- Malaise
- Loss of appetite
- Worsening dyspepsia despite PPI treatment
What will examination typically reveal?
Examination will be unremarkable in cases with only Barrett’s oesophagus with no further complications.
What investigation(s) are useful to reach a diagnosis of Barrett’s Oesophagus?
- OGD w/ biopsy (Histological diagnosis)
* Patients who have OGD for chronic / resistant GORD (or to exclude malignancy) should have a biopsy taken of the oesophageal epithelium and sent for histological analysis.
How does Barrett’s Oesophagus appear on OGD?
At OGD, the oesophagus appears red and velvety, with some preserved pale squamous islands.
How is Barrett’s Oesophagus managed?
- Proton-pump inhibitor (High dose & Twice daily)
-
Stopping medications that compromise gastic protection
* e.g. NSAIDs - Lifestyle advice
- To reduce the acidic stimulus on the squamous cells.
- Includes weight loss, smoking cessation, reducing consumption of fatty / spicy foods
-
Regular endoscopy
* Frequency of this depends on the degree of dysplasia identified by the biopsies (if any).
How frequently should patient’s with Barrett’s Oesophagus have regular endoscopy?
Why should patient’s with Barrett’s Oesophagus have regular endoscopy?
Due to risk of progression to adenocarcinoma.
Adenocarcinomas detected on routine screening for Barrett’s oesophagus are typically early-stage lesions and have a better prognosis than those discovered outside of any screening program.
How should high grade dysplasia be managed?
High risk of progressing to cancer so should be resected with:
Endoscopic mucosal resection (EMR)
OR
Endoscopic submucosal dissection (ESD)
