Case 1 - barrett's oesophagus

Question 1

what is Barrett’s oesophagus a complication of

Answer 1

long term oesophageal reflux

Question 2

what does it look like

Answer 2

a bit like white pasty finger like projections coming up from the bottom of the oesophagus

Question 3

what is Barrett’s defined by

Answer 3

> 3cm of columnar epithelium present at the bottom of the oesophagus

Question 4

what are the two mechanisms that could explain this

Answer 4

1. some argue that it is the migration of the epithelium of the bottom 2cm of the oesophagus further up the lumen - i.e the migration of essentially the gastric epithelium
2. others would say that as both squamous and columnar epithelium are derived from the same stem cells, it is just perhaps a change in the intra-luminal conditions that determine what those stem cells develop into; more acidic conditions will cause a columnar epithelium to form. the second idea is more popular

Question 5

what percentage of patients who have an endoscopy for reflux symptoms is it found in

Answer 5

10%

Question 6

what is it seen as endoscopically

Answer 6

seen as a pinker/redder epithelium as opposed to the whiter epithelium that lines the rest of the oesophagus. at first it may just extend up as thin bands of epithelium, but later it may encircle the entire lower oesophagus.

on microscopic examnation, the cells resemble those of the stomach, however they secrete intestinal like mucins, and as a result, Barrett’s oesophaagus is actually a form of intestinal metaplasia

Question 7

when does metaplasia normally occur

Answer 7

as a result of an environmental factor. it is when an existing epithelium is replaced by a different one; one that now has an advantage due to the change in environmental conditions

Question 8

what is it a major risk factor for

Answer 8

oesophageal adenocarcinoma

Question 9

what is Barrett’s described as

Answer 9

a ‘premalignant condition’ and patients who have it are at 100 times greater risk of cancer than the gen pop. this however, is still a relatively small risk overall and as such the patients overall risk of getting any cancer is still about 2-3%

Question 10

who is Barrett’s more commonly associated with

Answer 10

men >50

increased risk due to smoking but not drinking

Question 11

what does treatment and anti-reflux medicine do

Answer 11

absolutely fuck all - does not lead to recession