barrett's oesophagus

Question 1

definition of Barrett’s

Answer 1

metaplasia of the normal stratified squamous epithelium of the distal oesophagus to columnar epithelium

result of chronic GORD

Question 2

aetiology of barrett’s

Answer 2

chronic GORD

combined acid and bile reflux are the primary causative agents.

Question 3

RF for barrett’s

Answer 3

>50

obesity

male

white

FH or Barrett’s or oesophageal carcinoma

Question 4

epidemiology of Barrett’s

Answer 4

pts with history of symptomatic GORD rates approx 8%

screening in asymptomatic = approx 6%

Question 5

sx of barrett’s

Answer 5

GORD - retrosternal burning, antacids make it better, spicy food worse, alcohol worse (relaxes the LOS), acid brash

heart burn

risk factors

dysphagia - uncommon

chest pain

cough

dysponea

history of aspiration pneumonia

Question 6

signs of barrett’s

Answer 6

wheezing

laryngitis

Question 7

Ix for barrett’s

Answer 7

biopsy of endoscopically visible columnarisation allows histological corroboration

length should be recorded using Prague classification

Question 8

Mx of Barrett’s

Answer 8

focus on preventing oesophageal adenocarcinoma

risk of progression is low

RF for progression:

• increased age
• male
• long segment of oesophagus involved
• dysplasia

pts w/o dysplasia, length of involved oesophagus <3cm = discharged from surveillance programs, endoscopic assessment every 3yrs if appropriate

if high grade dysplasia/intramural carcinoma detected = endoscopic resection or mucosal radiofrequency ablation

low grade dysplasia - should be confirmed by repeat examination after 6mo prior to radiofrequency ablation

Question 9

complications of barrett’s

Answer 9

dysplasia and adenocarcinoma

oesophageal stricture

QOL deficit

Question 10

Px of barrett’s

Answer 10

adenocarcinomas discovered while screening for Barrett’s oesophagus are early-stage lesions and have good prognosis (5-year survival >85%).

Even with aggressive acid suppression, proton-pump inhibitor treatment does not lead to regression of Barrett’s oesophagus and the rate of progression to adenocarcinoma is approximately 0.25% to 0.4% per year

There are reports that anti-reflux surgery alone can lead to regression of Barrett’s oesophagus in more than 25% of patients, and that surgery lowers the risk for progression to adenocarcinoma.[86][87] Evidence is mixed, however.