General: Barrett’s Oesophagus

Question 1

What is the pathophysiology of barrets oesophagus?

Answer 1

Chronic gastro-oesophageal reflux disease

Metaplasia = normal stratified squamous epithelium is replaced by simple columnar epithelium

Question 2

List the risk factors for barretts oesophagus

Answer 2

Caucasian

Male

> 50yrs of age

Smoking

Obesity

Hiatus hernia

FH of Barrett’s oesophagus

Question 3

How does barretts oesophagus present?

Answer 3

Oesophagus = red and velvety, some preserved pale squamous islands

Retrosternal chest pain

Excessive belching

Odynophagia

Chronic cough

Hoarseness

Red flag = dysphagia, weight loss, early satiety, malaise and loss of appetite

Question 4

How should barretts oesophagus be investigated?

Answer 4

Biopsy + histology

Question 5

How should barretts oesophagus be managed?

Answer 5

Diagnosis = lifelong monitoring via endoscopy

PPI = typically high dose, twice daily

Meds that affect stomach defences should be stopped (NSAIDs)

Premalignant lesions = endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)

Carcinoma = oesophagectomy

Question 6

Name some possible complications of barretts oesophagus

Answer 6

Cancer = that can spread

Stricture

Ulceration