Barrett's Oesophagus Flashcards
what is the definition of barrett’s oesophagus?
Columnar linked lower oesophagus (CELLO) - american name
Metaplasia in lower oesophagus (squamous to glandular)
what is the epidemiology of barrett’s oesophagus?
The best estimate of the prevalence of Barrett’s oesophagus is between 0.5% and 2.0% of the general population.
The frequency of esophageal adenocarcinoma in men has quadrupled in the past few years. This may be linked to an increase in incidence of gastro-oesophageal reflux.
what is the aetiology of barrett’s oesophagus?
Gastro-oesophageal reflux
Combined acid and bile reflux
what are the risk factors for barrett’s oesophagus?
Middle age White Male GORD Tobacco use Obesity Family history
what is the pathophysiology of barrett’s oesophagus?
Metaplastic columnar stem cell development from a local (squamous epithelium stem cell) or bone marrow (bone marrow derived stem cell) source. The stem cell origin of Barrett’s oesophagus can explain its persistence and the predisposition to developing adenocarcinoma
goblet cells present
what are the key presentations of barrett’s oesophagus?
Presence of risk factors
Heartburn
Regurgitation
Dysphagia
what are the signs of barrett’s oesophagus?
Presence of risk factors
Dysphagia
Laryngitis
History of aspiration pneumonia
what are the symptoms of barrett’s oesophagus?
Heartburn Regurgitation Chest pain Cough Dyspnoea
what are the first line and gold standard investigations for barrett’s oesophagus?
Endoscopy with biopsy
Barium oesophagogram
what are the differential diagnoses for barrett’s oesophagus?
Oesophagitis
GORD
Oesophageal adenocarcinoma
Gastritis
how is barrett’s oesophagus managed?
reduce reflux of gastric acid into the oesophagus - Non-dysplastic: Proton pump inhibitors Anti-reflux surgery - low grade dysplasia: Endoscopic eradication therapies Endoscopic mucosal resection - high grade dysplasia: Endoscopic mucosal resection Endoscopic submucosal dissection Oesophagectomy
how is barrett’s oesophagus monitored?
There is no conclusive evidence that surveillance reduces mortality from oesophageal adenocarcinoma.
Recommend endoscopic surveillance every 3 to 5 years for non-dysplastic Barrett’s oesophagus
what are the complications of barrett’s oesophagus?
Dysplasia, adenocarcinoma, oesophageal stricture, quality of life deficit
what is the prognosis of barrett’s oesophagus?
the rate of progression to adenocarcinoma is approximately 0.25% to 0.4% per year with proton pump inhibitors
