Barrett's Oesophagus

Question 1

Define Barrett’s oesophagus

Answer 1

Metaplasia of oesophageal squamous epithelium and replacement with columnar epithelium induced by chronic reflux

Question 2

What is the pathophysiology of Barrett’s oesophagus?

Answer 2

Oesophagitis in response to reflux → stomach acid damages squamous epithelium of distal oesophagus → squamous epithelium replaced by columnar epithelium (METAPLASIA)

Question 3

What is the aetiology of Barrett’s oesophagus?

Answer 3

Main aetiology = GORD

Question 4

What are risk factors for Barrett’s oesophagus?

Answer 4

• Acid/bile reflux
• Increased age
• White ethnicity
• Male sex
• Smoking
• Obesity

Question 5

What is the epidemiology of Barrett’s oesophagus?

Answer 5

• Found in 2% of the general population
• Found in 5% of people with GORD
• Prevalence increases with age

Typically occurs in middle-aged white men who have had chronic GORD

Question 6

What are the presenting symptoms of Barrett’s oesophagus?

Answer 6

Symptoms of GORD:

• Substernal burning discomfort (i.e. ‘heartburn’)

Heartburn aggravated by:

• Lying supine
• Bending
• Large meals
• Drinking alcohol

Heartburn relieved by antacids

• Regurgitation of gastric contents → water brash (sour taste in mouth due to excessive saliva production mixing with gastric contents)

Question 7

What investigations would you do if you were suspecting Barrett’s oesophagus?

Answer 7

OGD and biopsy:

• histology would show columnar epithelium instead of squamous epithelium
• this can show if dysplasia is present and the grade

Question 8

What is the management of Barrett’s oesophagus?

Answer 8

No dysplasia:

• PPI therapy (to reduce reflux)
• Surveillance (every 2-5 years depending on the length of the affected segment)

Low-grade dysplasia:

• PPI therapy
• Surveillance (every 6 months)

High-grade dysplasia (pre-invasive stage):

• Oesophagectomy (patients fit for surgery)
• Endoscopic ablation or mucosal resection (patients unfit for surgery)

Question 9

What are the complications of Barrett’s oesophagus?

Answer 9

MAIN COMPLICATION

Premlaignant condition → increased risk of dysplasia and oesophageal adenocarcinoma

Question 10

What is the prognosis for Barrett’s oesophagus?

Answer 10

• 30-60 times increased risk of oesophageal adenocarcinoma
• Most patients will not develop oesophageal cancer and will die of other causes.
• 5-10% of those with Barrett’s oesophagus will develop adenocarcinoma over 10-20 years