Barrett's oesophagus

Question 1

What is Barrett’s oesophagus?

Answer 1

This is a change in the normal squamous epithelium of the oesophagus to specialised intestinal metaplasia.

Question 2

Which condition is Barrett’s oesophagus associated with?

Answer 2

GORD even if the reflux is asymptomatic

Question 3

What is essential to the diagnosis of Barrett’s oesophagus?

Answer 3

Histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells

Question 4

Causes of Barrett’s oesophagus

Answer 4

The primary cause is GORD

There is evidence that combined acid and bile reflux is the primary causative agents.

Question 5

Pathophysiology of Barrett’s oesophagus

Answer 5

A change in the oesophageal epithelium at any length that can be recognised at endoscopy.
There is confirmed intestinal metaplasia by biopsy of the tubular oesophagus and excludes intestinal metaplasia of the cardia.

Question 6

Signs and symptoms of Barrett’s oesophagus

Answer 6

Heartburn and regurgitation (symptoms of GORD)
Atypical symptoms include:
Dysphagia
Chest pain
Voice changes
Respiratory symptoms (reflux-induced asthma, reactive airway disease or aspiration pneumonia)

Question 7

Investigations of Barrett’s oesophagus

Answer 7

Upper GI endoscopy with biopsy- for biopsy, target areas of ulceration, narrowing or nodularity as they are more likely to contain areas of dysplasia and adenocarcinoma

Barium oesophagogram- Identifies hiatal hernia and reflux.
Considered as initial test in patients with dysphagia in order to evaluate for a mass lesion or stricture before endoscopy

Question 8

Differentials of Barrett’s oesophagus

Answer 8

Oesophagitis
GORD
Oesophageal adenocarcinoma
Gastritis

Question 9

Why is it important to monitor people with Barrett’s oesophagus?

Answer 9

This is to improve survival as lesions are detected early.
In the absence of dysplasia, surveillance intervals should be stratified according to the length of Barrett’s oesophagus
5 years- < 3cm
3 years- > 3cm

Question 10

Management of Barrett’s oesophagus

Answer 10

The goal of treatment of existing Barrett’s oesophagus is to reduce reflux of gastric acid into the oesophagus, thereby controlling symptoms

Question 11

Treatment of non-dysplastic Barrett’s oesophagus

Answer 11

-PPI plus surveillance (1st line)
-Radiofrequency ablation for patients at higher risk (should not be done routinely
-Patients at higher risk include:
White men >50 years of age
FHx of oesophageal adenocarcinoma
Long Barrett’s oesophagus segment
-Anti-reflux surgery plus surveillance (2nd line)
If the PPI doesn’t work

Question 12

Treatment of low-grade dysplasia Barrett’s oesophagus

Answer 12

Radiofrequency ablation with or without endoscopic mucosal resection.
Nodular lesions with low-grade dysplasia should be treated with endoscopic mucosal resection.

Question 13

Treatment of high-grade dysplasia Barrett’s oesophagus

Answer 13

Radiofrequency ablation with or without endoscopic mucosal resection and PPI (1st line)
Oesophagectomy (definitive treatment) - 2nd line

Question 14

Complications of Barrett’s oesophagus

Answer 14

Dysplasia and adenocarcinoma
Oesophageal stricture
Quality of life deficit