Barrett's oesophagus Flashcards
Define Barrett’s oesophagus
Prolonged exposure of normal squamous epithelium to refluxate of GORD leads to mucosal inflammation & erosion, leading to replacement of mucosa w/ metaplastic columnar epithelium
Metaplastic change:
squamous —> columnar
Aetiology of Barrett’s oesophagus
2
Reflux occurs if cardiac sphincter is not working properly
Hiatus hernias make GORD more likely
Epidemiology of Barrett’s oesophagus
heartburn + GORD relationship
1/10 adults have daily heartburn
3-5% people w/ GORD develop Barrett’s oesophagus
Presenting symptoms of Barrett’s oesophagus
general + 6
Likely to experience symptoms of GORD:
Heartburn Nausea Waterbrash Bloating Belching Burning pain when swallowing
Signs of Barrett’s oesophagus on physical examination
N/A - symptoms
Investigations & findings for Barrett’s oesophagus
OGD & biopsy
Shows replacement of squamous epithelium w/ columnar epithelium
Groups of management of Barrett’s oesophagus
3
Pre malignant/high grade dysplasia
Low grade dysplasia
No pre malignant changes found
Management of Barrett’s oesophagus - Pre malignant/high grade dysplasia
(2 + 2)
Oesophageal resection
Eradicative mucosectomy
Other techniques:
Endoscopic targeted mucosectomy
Mucosal ablation by epithelial laser, radio frequency (HALO) or photodynamic ablation (PD)
Management of Barrett’s oesophagus - Low grade dysplasia
1
Annual endoscopic surveillance is recommended
Management of Barrett’s oesophagus - No pre malignant changes found
(2)
Surveillance endoscopy & biopsy every 1-3 years
Anti reflux measures (e.g. high dose PPI)
Complications of Barrett’s oesophagus
MAIN COMPLICATION - development of oesophageal adenocarcinoma
Risk of dysplasia
Prognosis for Barrett’s oesophagus
adenocarcinoma risks
30-60x higher risk of oesophageal adenocarcinoma than general population
5-10% develop adenocarcinoma over 10-20 years
