Barrett's Oesophagus

Question 1

Define

Answer 1

Results from the prolonged exposure of normal distal oesophageal squamous epithelium to the refluxes of GORD

Causes mucosal inflammation and erosion

• Leading to replacement of mucosa with metaplastic columnar epithelium
• I.e. squamous → columnar
• The length affected may be a few centimetres or the whole oesophagus
• May be continuous or patchy
• Significant associated morbidity is oesophageal adenocarcinoma

Question 2

Causes

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

Risk factors

Answer 3

3-5% of people with GORD develop Barrett’s
↑risk with longer duration and increase frequency of symptoms

Question 4

Epidemiology

Answer 4

More common in men
More common in Caucasians

↑prevalence with age

Question 5

Symptoms

Answer 5

Patients are likely to experience symptoms of GORD:

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

Question 6

Signs

Answer 6

• Epigastric tenderness occasionaly
• Wheeze on auscultation and dyspnoea

Question 7

Investigations

Answer 7

OGD and Biopsy

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

Question 8

Management

Answer 8

Pre-malignant/High grade dysplasia:

• Oesophageal resection
• Eradicative mucosectomy NOTE: this is appropriate if the patients are young and fit

Other techniques:

• Endoscopic targeted mucosectomy
• Mucosal ablation by epithelial laser, radiofrequency (HALO) or photodynamic ablation (PD)

Low-grade dysplasia

• annual endoscopic surveillance is recommended

No pre-malignant changes found:

• Surveillance endoscopy and biopsy performed every 1-3 years
• Anti-reflux measures (e.g. high dose PPI)

Question 9

Complications

Answer 9

MAIN COMPLICATION: development of oesophageal adenocarcinoma

Risk of dysplasia

Question 10

Rrognosis

Answer 10

• 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