PC Barrett's Oesophagus and Diverticular Disease

Question 1

Barrett’s Oesophagus

Answer 1

Distal oesophagus is lined by columnar cells due to metaplasia; the oesophagus is lined by gastric mucosa, which can develop goblet cells and another process - intestinal metaplasia
Risk factors: high BMI, alcohol, tobacco, drugs which relax the lower oesophageal sphincter, familial predispositions

Question 2

Pathogenesis of BO

Answer 2

Reflux of acidic contents from the stomach into the oesophagus leads to reflux oesophagitis
Squamous epithelium changes to columnar epithelium in a process of metaplasia
The metaplastic process is an adaption to injury caused by the gastric contents
Columnar epithelium increases the risk of adenocarcinoma of the oesophagus through a precancerous stage called dysplasia
Squamous epithelium -> reflux oesophagi’s -> gastric epithelium -> intestinal metaplasia -> low grade dysplasia -> high grade dysplasia -> adenocarcinoma

Question 3

Risk factors for dysplasia in Ulcerative Colitis

Answer 3

UC at an early age
Total UC – involving the whole large bowel
Repeated bouts of acute inflammation with short periods of remission
Long duration with UC; patients with total UC for 8 years require annual surveillance colonoscopy to look for dysplasia

Question 4

Diverticular Disease

Answer 4

Outpouchings as a result of herniation of the mucosa and submucosa through the bowel wall at sites of weakness
Common in the populations on low fibre diet
95% affect the sigmoid colon
Can be complicated with diverticulitis and perforation -> peritonitis
Can be present with intestinal obstruction
Can mimic cancer
Colo-vesical fistula and patient presents with pneumaturia