Barrett's Oesophagus

Question 1

What is Barrett’s Oesophagus?

Answer 1

Metaplasia where the stratified squamous epithelium of the oesphagus are replaced by columnar epithelium.

Question 2

Why does the metaplasia occur?

Answer 2

To protect the oesophagus as the columnar epithelial cells have faster regeneration

Question 3

Who gets Barrett’s oesophagus?

Answer 3

Patients with persistent reflux of acid or bile (GORD), often there is a hiatus hernia as well
-People with central obesity

Question 4

How does BARRETT’S Present?

Answer 4

Microscopic - oesophagus is lined with intestinal metaplasia

Question 5

How is Barrett’s diagnosed?

Answer 5

If endoscopy shows proximal displacement of squamocolumnar mucosal junction and biopsy demonstrates columnar lining above the proximal gastric folds (>1cm)
-Prague classification quantifies Barrett’s oesophagus

Question 6

How is Barrett’s Treated?

Answer 6

Frequent surveillance is required
Optimize PPI dose 
Endoscopic mucosal resection (EMR)
Radiofrequency ablation (HALO)
Argon

Question 7

What is the prognosis/side effects/complications?

Answer 7

Mucosa is unstable so increased risk of developing dysplasia and adenocarcinoma