Barrett's Oesophagus Flashcards
What is Barrett’s oesophagus BO?
Metaplasia of the oesophageal epithelial lining.
Normal stratified -> simple columnar
Epidemiology
0.5-2% in western world
Around 10% with GORD will have it.
Pathophysiology
Abnormal reversible change of one cell type to another.
Normal stratified squamous goes to simple columnar in BO
Usually due to GORD where the oesophagus lining becomes damaged by the reflux leading to metaplasia.
This increases the risk of developing dysplastic and neoplastic changes.
What part of the oesophagus is mainly affected?
Distal oesophagus most commonly.
What does diagnosis rely upon
Biopsy with presence of simple columnar epithelium.
Risk factors
Caucasian
Male
>50yo
GORD
Smoking
Obesity
Presence of hiatus hernia
+ve FH of BO
Clinical features
Hx of GORD
Retrosternal chest pain, excessive belching, odynophagia, chronic cough and hoarseness of voice.
Red flag symptoms
Dysphagia
Weight loss
Early satiety
Malaise
Loss of appetite
Worsening dyspepsia despite PPIs
Examination findings
Usually unremarkable
Investigations
Histological diagnosis
Patients who undergo OGD for chronic or resistant gord should have a biopsy taken as well to investigate the oesophageal epithelium.
What does the oesophagus look like in BO on OGD?
Red and velvety with some preserved pale squamous islands
Management
PPIs high dose twice daily
Any medication such as NSAIDs should be stopped
Lifestyle advice
Follow-up on BO
Major risk of BO is progression to adenocarcinoma
All patients with confirmed BO must undergo regular endoscopy
How often should endoscopy be done in BO?
Depends on the histology of the biopsy samples.
Prognosis of BO
High grade dysplasia has a high risk of progressing to cancer so it needs to be resected with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).
