Case 1 - barrett's oesophagus Flashcards
what is Barrett’s oesophagus a complication of
long term oesophageal reflux
what does it look like
a bit like white pasty finger like projections coming up from the bottom of the oesophagus
what is Barrett’s defined by
> 3cm of columnar epithelium present at the bottom of the oesophagus
what are the two mechanisms that could explain this
- some argue that it is the migration of the epithelium of the bottom 2cm of the oesophagus further up the lumen - i.e the migration of essentially the gastric epithelium
- others would say that as both squamous and columnar epithelium are derived from the same stem cells, it is just perhaps a change in the intra-luminal conditions that determine what those stem cells develop into; more acidic conditions will cause a columnar epithelium to form. the second idea is more popular
what percentage of patients who have an endoscopy for reflux symptoms is it found in
10%
what is it seen as endoscopically
seen as a pinker/redder epithelium as opposed to the whiter epithelium that lines the rest of the oesophagus. at first it may just extend up as thin bands of epithelium, but later it may encircle the entire lower oesophagus.
on microscopic examnation, the cells resemble those of the stomach, however they secrete intestinal like mucins, and as a result, Barrett’s oesophaagus is actually a form of intestinal metaplasia
when does metaplasia normally occur
as a result of an environmental factor. it is when an existing epithelium is replaced by a different one; one that now has an advantage due to the change in environmental conditions
what is it a major risk factor for
oesophageal adenocarcinoma
what is Barrett’s described as
a ‘premalignant condition’ and patients who have it are at 100 times greater risk of cancer than the gen pop. this however, is still a relatively small risk overall and as such the patients overall risk of getting any cancer is still about 2-3%
who is Barrett’s more commonly associated with
men >50
increased risk due to smoking but not drinking
what does treatment and anti-reflux medicine do
absolutely fuck all - does not lead to recession