Barrett's Oesophagus

Question 1

Define Barrett’s Oesophagus

Answer 1

Barrett’s oesophagus is a change in the normal oesophageal squamous epithelium to columnar epithelium. This is associated with GORD, even if the reflux is asymptomatic

Question 2

Explain the aetiology/risk factors for Barrett’s Oesophagus

Answer 2

• The primary aetiological factor involved in Barrett’s oesophagus is GORD.
• However, there is evidence that combined acid and bile reflux are the primary causative agents
• Oesophageal lining turns into columnar epithelium instead of the normal squamous epithelium
• This is a premalignant change
• Histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells

Risk Factors:

• Acid/Bile reflux (GORD)
• Increased age
• White Male
• FHx of Barrett’s or Oesophageal cancer

Question 3

Presenting symptoms of Barrett’s Oesophagus

Answer 3

PRESENTS LIKE GORD

• Heartburn
• Regurgitation
• Dysphagia (uncommon)

Question 4

Investigations for Barrett’s Oesophagus

Answer 4

• Upper GI endoscopy & BIOPSY (DIAGNOSTIC!)
  
  • Will show abnormal epithelium (velvety look)
• Barium swallow: Can identify reflux

Question 5

Generate a management plan for Barrett’s oesophagus

Answer 5

• full-dose PPI
• endoscopic surveillance every 3-5 years if METPLASIA
• If any dysplastic change detected –> endoscopic intervention
  
  • Radiofrequency ablation
  • mucosal resection

Question 6

Complications of Barrett’s Oesophagus

Answer 6

• Dysplasia and adenocarcinoma
• Oesophageal stricture