Unit 9: Minor 2 Barret's Oesophagus Flashcards
What are the histological signs of GERD?
Basal cell hyperplasia
Papillary elongation
Dilation of intracellular spaces
Inflammatory infiltration
Erosions with potential for fibrosis
Describe the histological changes present in Barret’s Oesophagus.
Metaplastic changes
Transition from stratified sqaoumous epithelium to specialised columnar epithelium
- simple columnar epithelial cells
- goblet cells and villus architecture
OR
- mimic gastric glands with mucus neck cells
What is the pathogenesis of Barrett esophagus?
Is a complication of chronic GERD.
Direct damage from acid and indirect damage from inflammation is persistent.
Metaplastic change occurs as an adaptation to cellular injury, repeated acid damage triggers the cellular change and alters gene expression to change the epithelial type.
What patients are at risk for developing Barrett Oesophagus?
GERD patients - late diagnosis or poor treatment (either low compliance in incorrect medication)
Obesity - fat around the abdomen increased intrabdominal pressure
Diet - spicy food, alcohol, caffeine can increase the risk of acid reflux
Age - over 50yrs (prolonged cell damage)
Anatomical deficit - weekend lower oesophageal sphincter
What condition is Barrets Oesophagus a risk factor for?
Why?
Esophageal adenocarcinoma - stepwise aquisistion of epigenetic and genetic changes, loss of TSG function and gain of oncogene function.
Metaplasia increases risk of dysplasia, occurs through further DNA changes.
What is oesophageal adenocarcinoma?
Typically affects 60-70yrs males
Risk: long standing GERD/Barrets oesophagus
Typically occurs in the lower third of the oesophagus.
Cancer of glandular tissue - irregular glands lined with hyperchromatic nuclei, amy have some growth of fibrous or connective tissue
What are four potential causes of eosophagitis?
Reflux eosophagitis - associated with GERD
Physical agents - indigestion or irridation such as swallowing bleech
Eosinophilic oesophagitis -
Infectious agents - typically only affects the immunosuppressed
What is eosinophilic eosophagitis?
Typically due to an allergic reaction to food, antigen detected by Langerhan cells in oesophagus, results in eosinophil rich inflammation.
Appears as corrugate rings in the oesophagus
What is the most common infectious cause of eosophagitis?
Candida albicans
Herpes Simplex Virus
Cytomegalo virus
- typically only occurs in the immunosuppressed
What are the most common types of eosophageal carcinomas?
Oesophageal adenocarcinoma
Squamous cell carcinoma
What are the features of oesophageal sqaoumous cell carcinoma?
Cancer in the squamous cells of the oesophagus - identifiable feature of keratin pearls
Typically in the upper two thirds of the esophagus
Main risk factors: Tobacco and alcohol use
Least common in America
What is shown in the image below?
A. Adenocarcinoma
B. Squamous cell carcinoma
What is shown in the image below?
Transitoin from the normal oesophageal gastric junction to Barretts oesophagus.
What are the features of the following endoscopes?
Top: Barrets oesophagus (red patches), an example of reflux eosophagitis
Bottom: eosinophilic eosophagitis
What are the symptoms of GERD?
Acid reflux
Hoarseness
Pain and difficulty swallowing
Bad Breath
Nausea
Belching and bloating
