Barrett's Oesophagus

Question 1

Define Barrett’s oesophagus

Answer 1

Change in normal squamous epithelium of the oesophagus to specialised intestinal columnar metaplasia, usually of the lower oesophagus

Question 2

Aetiology of Barrett’s oesophagus

Answer 2

Gastro-oesophageal reflux
Acid and bile reflux are the primary causative agents
Metaplasia - squamous -> columnar

Question 3

Risk factors for Barrett’s oesophagus

Answer 3

GORD
Acid/bile reflux 
Male 
Obesity (central)
Smoking 
Increased age
White
Family history

Question 4

Presenting symptoms of Barrett’s oesophagus

Answer 4

Asymptomatic, presents with GORD

Heartburn 
Regurgitation 
Dysphasia 
Chest pain
Cough 
Dyspnoea or wheezing

Question 5

Signs of Barrett’s oesophagus on examination

Answer 5

Laryngitis

Dyspnoea or wheeze

Question 6

Investigations for Barrett’s oesophagus

Answer 6

Upper GI endoscopy (OGD) + biopsy: Violaceous epithelium proximal to the gastro-oesophageal junction. Shows columnar-lined epithelium ± intestinal metaplasia and goblet cells

Barium oesophagogram: hiatal hernia and reflux (test in patients with dysphagia)

Question 7

Management for non-dysplastic Barrett’s oesophagus

Answer 7

1. High dose PPI (esomeprazole) + endoscopic surveillance every 5 years
2. Radiofrequency ablation
3. Anti-reflux surgery

Question 8

Management for low-grade dysplasia and high-grade dysplasia for Barrett’s oesophagus

Answer 8

Low-grade: radio frequency ablation ± endoscopic mucosal resection

High-grade: radiofrequency ablation ± endoscopic mucosal resection
+ PPI
OR oesophagectomy

Question 9

Complications of Barrett’s oesophagus

Answer 9

Increased risk of adenocarcinoma
Dysphasia
Oesophageal stricture
Quality of life reduction e.g. reflux, depression, anxiety

Question 10

Prognosis of Barrett’s oesophagus

Answer 10

Adenocarcinomas discovered while screening for Barrett’s have good prognosis
PPI does not lead to regression, only symptomatic relief