Barrett's oesophagus

Question 1

What is Barret’s oesophagus?

Answer 1

prolonged exposure to refluxate of GORD leads to mucosal inflammation + erosion, leads to replacement of mucosa with metaplastic columnar epithelium
Metaplastic change: Squamous to Columnar

Question 2

Describe the aetiology of Barret’s oesophagus

Answer 2

Reflux occurs if the cardiac sphincter is not working (mostly idiopathic)
Hiatus hernia make GORD more likely

Question 3

List 4 risk factors for Barret’s oesophagus

Answer 3

Acid reflux / GORD
Increased age
White ethnicity
Male

Question 4

Describe the epidemiology of Barret’s oesophagus

Answer 4

1/10 adults have heart burn daily

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

Question 5

List 7 symptoms of Barret’s oesophagus

Answer 5

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

Question 6

List 3 signs of Barret’s oesophagus

Answer 6

Wheeze
Dyspnoea
Cough

Question 7

What investigations should be performed in Barrett’s oesophagus?

Answer 7

OGD + Biopsy

Shows replacement of squamous with columnar epithelium

Question 8

How is non dysplastic Barrett’s oesophagus managed?

Answer 8

PPI + surveillance (endoscopy every 2 years)
Radiofrequency ablation (if high risk)

Question 9

How is low grade dysplastic Barrett’s oesophagus managed?

Answer 9

Radiofrequency ablation

+ PPI

Question 10

How is high grade dysplastic Barrett’s oesophagus managed?

Answer 10

Radiofrequency ablation + PPI +/- endoscopic mucosal resection
2nd line: oesophagectomy

Question 11

List complications of Barrett’s oesophagus

Answer 11

Oesophageal adenocarcinoma

Dysplasia

Question 12

What is the prognosis in Barrett’s oesophagus?

Answer 12

30-60X higher risk of oesophageal adenocarcinoma than general pop
Most DONT develop oesophageal adenocarcinoma
5-10% of Barrett’s develop adenocarcinoma over 10-20 years