Barret's oesophagus Flashcards
define Barret’s oesophagus?
Prolonged exposure of the normal squamous epithelium to refluxate of GORD leads to mucosal inflammation and erosion, leading to replacement of the mucosa with metaplastic columnar epithelium
what is the metaplastic change that occurs in Barret’s oesophagus?
startified squamous-> Simple columnar
what is the main problem with barret’s oesophagus?
progresses to oesophageal adenocarcinoma
outline the aetiology of barret’s oesophagus?
gastro-oesophageal reflux-> evidence that combined acid and bile reflux are primary causative agents
reflux occurs if LOS not working
Hiatus hernia makes GORD more likely
what are the risk factors for barret’s oesophagus?
acid/bile reflux or GORD
increased age
white ethnicity
male sex
summarise the epidemiology of barret’s oesophagus?
1/10 adults have heart burn every day
3-5% of people with GORD will develop Barrett’s oesophagus
what are the symptoms and signs of barret’s oesophagus?
Heartburn
Nausea
Water-brash (sour taste in the mouth)
Bloating
Belching
Burning pain when swallowing
what are the investigations for barret’s oesophagus?
upper GI endoscopy with biospy-> show replacement of squamous epithelium with columnar epithelium
Barium oesophagogram- may be considered as an initial test in patients with dysphagia in order to evaluate for a mass lesion of stricuture before endoscopy but this can’t diagnose Barrett’s (can only identify stricture or hiatal hernia)
what are the complications of barret’s oesophagus?
development of oesophageal adenocarcinoma
Risk of dysplasia
summarise the prognosis for patients with barret’s oesophagus?
Barrett’s oesophagus carries a 30-60 times higher risk of oesophageal adenocarcinoma than the general population
Most patients, however, do not develop oesophageal adenocarcinoma
5-10% of those with Barrett’s oesophagus will develop adenocarcinoma over 10-20 years
what is the management for high grade dysplasia barret’s oesopahgus?
radiofrequency ablation + PPI with or without endoscopic mucosal resection (most likely with)
2nd line: oesophagectomy
what is the management for low grade ( Nodule only) barret’s oesophagus?
endoscopic mucosal resection + PPI
what is the management for non- dysplastic barret’s oesophagus?
PPI (esomeprazole or omeprazole – 20mg once daily then increase to twice daily) + surveillance
May offer radiofrequency ablation as adjunctant ONLY if high risk of adenocarcinoma development e.g. white men > 50yrs with FHx and a long segment of barrett’s
