Barrett's Oesphagus Flashcards
Define Barrett’s oesophagus and summarise its aetiology and epidemiology.
Definition: Prolonged exposure of the normal squamous epithelium to refluxate of GORD leads mucosal inflammation and its replacement with metaplastic columnar epithelium (Change from squamous to columnar). This could lead to oesophageal adenocarcinoma
Aetiology/ risk factors:
- Reflux will occur if cardiac sphincter is not working properly
- Hiatus hernia make GORD more likely
Epidemiology:
- 1/10 adults have heart burn every day
- 3-5% of people with GORD will develop Barrett’s oesophagus
Describe the history/presenting symptoms of Barrett’s oesophagus
Patients are likely to experience symptoms of GORD:
- Heartburn
- Nausea
- Water-brash (sour taste in mouth)
- Bloating
- Belching
- Burning pain when swelling
- Chest pain
- Laryngitis
- Cough
- Dyspnoea or wheezing
What are the signs of Barrett’s Oesophagus upon physical examination?
What investigations are used to identify Barrett’s Oesophagus?
Signs:
- Look at symptoms
Investigation:
- 1st investigations to order:
o Upper GI endoscopy with biopsy
o Barium oesophagogram
- This will show the replacement of the squamous epithelium with columnar epithelium
How is Barrett’s Oesophagus managed?
ACUTE
Non-dysplastic Barrett’s oesophagus:
- 1st line: proton-pump inhibitor plus surveillance
- Adjunct: radiofrequency ablation
- 2nd line: anti-reflux surgery plus surveillance
Low-grade dysplasia:
- 1st line: radiofrequency ablation with or without endoscopic mucosal resection. Annual endoscopic surveillance is recommended
High-grade dysplasia:
- 1st line: radiofrequency ablation with or without endoscopic mucosal resection
Plus proton-pump inhibitor
2nd line: oesophagectomy
What are the complications of Barrett’s Oesophagus?
Summarise the prognosis for patients with Barrett’s Oesophagus
Complication: Development of oesophagela adenocarcinoma and risk of dysplasia
Prognosis: Barrett’s oesophagus carries a 30-60x higher risk of oesophageal adenocarcinoma than rest of population.
Most patients don’t develop it.
5-10% of those with the condition will develop adenocarcinoma over 10-20 years
