Barrett's Oesophagus

Question 1

Define Barrett’s Oesophagus?

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

Question 2

What is the metaplastic change that happens in Barrett’s Oesophagus?

Answer 2

Squamous leads to Columnar

Question 3

What is the main problem with Barrett’s Oesophagus?

Answer 3

Barrett’s could progress to oesophageal adenocarcinoma

Question 4

What is the aetiology of Barrett’s Oesophagus?

Answer 4

Reflux will occur if the cardiac sphincter is not working properly (most of the time it is unclear why it is not working problem)
Hiatus Hernia make GORD more likely

Question 5

What is the epidemiology of Barrett’s Oesophagus?

Answer 5

1/10 adults have heart burn every day

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

Question 6

What are the presenting symptoms of Barrett’s Oesophagus?

Answer 6

Patients are likely to experience symptoms of GORD:

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

Question 7

What investigations do you do for Barrett’s Oesophagus?

Answer 7

OGD and Biopsy

Question 8

Why do we do OGD and Biopsy for Barrett’s Oesophagus?

Answer 8

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

Question 9

What is the management plan for Pre-Malignant/High grade dysplasia in Barrett’s Oesophagus?

Answer 9

Oesophageal resection

Eradicative mucosectomy

Question 10

What are the other techniques for Barrett’s Oesophagus management?

Answer 10

Endoscopic targeted mucosectomy

Mucosal ablation by epithelial laser, radiofrequency (HALO) or photodynamic ablation (PD)

Question 11

What do you do for Low-Grade Dysplasia for Barrett’s Oesophagus?

Answer 11

Annual endoscopic surveillance is recommended

Question 12

What do you do for Barrett’s Oesophagus if there are no pre-malignant changes found?

Answer 12

Surveillance endoscopy and biopsy performed every 1-3 years

Anti-reflux measures (e.g. high dose PPI)

Question 13

What is the main complications of Barrett’s Oesophagus?

Answer 13

Development of Oesophageal Adenocarcinoma

Question 14

What is the other complications of Barrett’s Oesophagus?

Answer 14

Risk of dysplasia

Question 15

What is the prognosis for patients with Barrett’s Oesophagus?

Answer 15

Barrett’s Oesophagus carries a 30-60 times higher risk of oesophageal adenocarcinoma than the general population
Most patients, however, don’t develop oesophageal adenocarcinoma
5-10% of those with Barrett’s Oesophagus will develop adenocarcinoma over 10-20 years