Barrett's Oesophagus

Question 1

What is Barrett’s oesophagus?

Answer 1

It is defined as a condition in which there is metaplasia of the lower oesophageal mucosa

It is a pre-malignant condition resulting in an increased risk of developing oesophageal adenocarcinoma

Question 2

What epithelial transformation occurs in Barrett’s oesophagus?

Answer 2

Stratified squamous epithelium

TRANSFORMED INTO

Simple columnar epithelium

Question 3

Describe the pathophysiology of Barrett’s oesophagus

Answer 3

Barrett’s oesophagus is most commonly associated with gastro-oesophageal reflux disease (GORD), which is defined as a condition in which gastric acid refluxes from the stomach through the lower oesophageal sphincter and irritates the lining of the oesophagus

This irritation over a prolonged period of time precipitates the metaplasia, in which oesophageal epithelium transforms into gastric/intestinal epithelium as a protective mechanism

Question 4

What classification system is used in Barrett’s oesophagus?

Answer 4

Prague C & M Classification System

Question 5

What does the ‘C’ in the ‘Prague C & M Classification System’ represent?

Answer 5

Circumferential Extent of Disease

This is defined as the distance from the gastro-oesophageal junction to the highest location metaplasia is present around the entire circumference of the oesophagus

Question 6

What does the ‘M’ in the ‘Prague C & M Classification System’ represent?

Answer 6

Metaplasia Extent of Disease

It is defined as the distance from the gastro-oesophageal junction to the highest location of metaplasia

Question 7

What does a high ‘Prague C & M Classification System’ score represent?

Answer 7

It demonstrates that the disease is more severe, and therefore there is a greater risk of malignant transformation

Question 8

What are the six risk factors of Barrett’s oesophagus?

Answer 8

Gastro-Oesophageal Reflux Disease (GORD)

Male Gender

Older Age

White Ethnicity

Central Obesity

Smoking

Question 9

What is the most common risk factor of Barrett’s oesophagus?

Answer 9

Gastro-Oesophageal Reflux Disease (GORD)

Question 10

In general, how does Barrett’s oesophagus present?

Answer 10

Asymptomatically

However, individuals may experience the clinical features of GORD

Question 11

What are the eight clinical features associated with Barrett’s oesophagus?

Answer 11

Heartburn

Acid Regurgitation

Dysphagia

Epigastric Pain

Abdominal Distension

Nocturnal Cough

Hoarse Voice

Weight Loss

Question 12

What is the gold standard investigation used to diagnose Barrett’s oesophagus?

Answer 12

Endoscopy + Biopsy

Question 13

What are the three histology features of Barrett’s oesophagus?

Answer 13

Salmon Columnar Epithelium Above Gastro-Oesophageal Junction (GOJ)

Goblet Cells

Brush Border

Question 14

What is the minimum length of epithelial changes above the GOJ required for a diagnosis of Barrett’s oesophagus?

Answer 14

1cm

Question 15

What are the four management options used to treat Barrett’s oesophagus?

Answer 15

Proton Pump Inhibitors

Endoscopic Surveillance + Biopsy

Radiofrequency Ablation (RFA)

Endoscopic Resection

Question 16

Name two proton pump inhibitors (PPIs)

Answer 16

Omeprazole

Lansoprazole

Question 17

When are PPIs used to manage Barrett’s oesophagus?

Answer 17

It is recommended in all Barrett’s oesophagus patients

Question 18

How do PPIs manage Barrett’s oesophagus?

Answer 18

They inhibit gastric acid secretion by binding to the hydrogen potassium ATPase pump that resides on the luminal surface of the parietal cell membrane

This provides time for the damaged oesophageal tissue to heal, inducing regression of lesions and reducing the change of progression to dysplasia

Question 19

When is endoscopic surveillance, with biopsies, used to manage Barrett’s oesophagus?

Answer 19

It is recommended in Barrett’s oesophagus with evidence of metaplasia, however no dysplasia features

Question 20

How often do we conduct endoscopic surveillance in individuals with a metaplasia distance < 3cm?

Answer 20

3 - 5 years

Question 21

How often do we conduct endoscopic surveillance in individuals with a metaplasia distance > 3cm?

Answer 21

2 - 3 years

Question 22

What is radiofrequency ablation (RFA)?

Answer 22

It involves the application of heat generated by radio waves to ablate dysplastic oesophageal tissue

Question 23

When is radiofrequency ablation (RFA) used to manage Barrett’s oesophagus?

Answer 23

It is the first line management option in Barrett’s oesophagus, with dysplasia features – particularly low grade dysplasia or high grade dysplasia with no visible lesions

Question 24

What is endoscopic resection?

Answer 24

It involves endoscopic removal of dysplastic oesophageal tissue from the oesophagus

Question 25

When is endoscopic resection used to manage Barrett’s oesophagus?

Answer 25

It is the first line management option in Barrett’s oesophagus, with dysplasia features –high grade dysplasia with visible lesions