The Oesophagus - Barrett's Oesophagus

Question 1

Epidemiology of Barrett’s Oesophagus.

Answer 1

Approximately 10% of patients with long-standing GORD.

Question 2

Risk Factors of Barrett’s Oesophagus (4).

Answer 2

1. GORD (Strongest).
2. Males (7:1).
3. Smoking.
4. Central Obesity.

Question 3

Pathophysiology of Barrett’s Oesophagus (3).

Answer 3

1. Metaplastic process in the lower oesophageal mucosa.
2. Adaptive Response to prolonged injury caused by GORD.
3. Squamous Epithelium - Glandular Columnar Epithelium.

Question 4

Clinical Features of Barrett’s Oesophagus (3).

Answer 4

1. Asymptomatic.
2. Incidental - Upper GI Endoscopy.
3. Improvement in Reflux Symptoms.

Question 5

Classification of Barrett’s Oesophagus (3).

Answer 5

1. Short < 3cm.
2. Long > 3cm.
3. Length correlates with chances of identifying metaplasia.

Question 6

Management of Barrett’s Oesophagus (2).

Answer 6

1. Regular Surveillance Endoscopies (3-5 years) and Biopsies : identify and eradicate any dysplasia by radio frequency ablation or endoscopic mucosal resection before it develops into an adenocarcinoma.
2. PPIs - High-Dose

Question 7

Prognosis of Barrett’s Oesophagus (2).

Answer 7

1. Small minority - metaplastic columnar epithelium can undergo dysplasia to become an invasive adenocarcinoma.
2. Metaplasia - Dysplasia - Carcinoma Sequence.