Barrett's Oesophagus

Question 1

Definition

Answer 1

· Prolonged exposure of the normal squamous epithelium to refluxate of GORD leads to mucosal inflammation and erosion, leading to replacement of the mucosa with metaplastic columnar epithelium

· Metaplastic change: Squamous —-> Columnar

Question 2

Aetiology/Risk factors

Answer 2

· Reflux will occur if the cardiac sphincter is not working properly (most of the time it is unclear why it is not working properly)

· Hiatus hernia make GORD more likely

Question 3

Epidemiology

Answer 3

· 1/10 adults have heart burn every day

· 3-5% of people with GORD will develop Barrett’s oesophagus

Question 4

Presenting symptoms

Answer 4

· Patients are likely to experience symptoms of GORD:

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

Question 5

Investigations

Answer 5

· OGD and Biopsy

o This will show the replacement of the squamous epithelium with columnar epithelium

Question 6

Management plan

Answer 6

· Pre-malignant/High grade dysplasia:
o Oesophageal resection
o Eradicative mucosectomy
o NOTE: this is appropriate if the patients are young and fit

· Other techniques:
o Endoscopic targeted mucosectomy
o Mucosal ablation by epithelial laser, radiofrequency (HALO) or photodynamic ablation (PD)

· Low-grade dysplasia - annual endoscopic surveillance is recommended

· No pre-malignant changes found:
o Surveillance endoscopy and biopsy performed every 1-3 years
o Anti-reflux measures (e.g. high dose PPI)

Question 7

Possible complications

Answer 7

· MAIN COMPLICATION: development of oesophageal adenocarcinoma

· Risk of dysplasia

Question 8

Prognosis

Answer 8

· Barrett’s oesophagus carries a 30-60 times higher risk of oesophageal adenocarcinoma than the general population

· Most patients, however, do not develop oesophageal adenocarcinoma

· 5-10% of those with Barrett’s oesophagus will develop adenocarcinoma over 10-20 years