Barrett's oesophagus

Question 1

Pathogenesis

Answer 1

• long standing reflux of duodenogastric content–> lower oesophageal epithelium (stratified squamous epithelium) undergoes metaplasia–> intestinal type columnar epithelium–> continued inflammation–> dysplasia–> adenocarcinoma (lower third of oesophagus/ gastro-oesophageal junction)

Question 2

Aetiology

Answer 2

• male smoker
• long history (over 10 years) of Barrett’s metaplasia
• frequent symptoms of gastro-oesophageal reflux (> 3 times a week)

Question 3

Investigation

Answer 3

• endoscopy: area of ‘salmon’ pink columnar mucosa replacing pearly white squamous epithelium

Question 4

Treatment

Answer 4

• PPI +- antireflux surgery
• high-grade dysplasia: endoluminal therapy (endoscopic mucosal resection, radiofrequency ablation or photodynamic therapy)/ oesophagogastrectomy