And that’s ‘oesophagus’, with an ‘O’. None of this dropping ‘O’s from the beginning of words. Oedema, oesophagus. You see, if you take out the ‘O’, it’s a completely different sounding word.
Definition: metaplasia of the distal oesophageal epithelium from squamous to columnar, due to prolonged exposure to the refluxate of GORD.
Aetiology/ risk factors:
-caused by prolonged gastro-oesophageal reflux disease (GORD), which causes mucosal inflammation and erosion, leading to replacement of the normal squamous epithelium with metaplastic columnar epithelium
3-5% of people with GORD develop Barrett’s
More common in older, white, males
Symptoms & Signs:
-They will have signs and symptoms of GORD e.g. heartburn and regurgitation
Endoscopy + biopsy- biopsy of endoscopically visible columnarisation allows histological collaboration (using Prague criteria)
Columnar epithelium looks velvety. The length affected may be a few cm or all the oesophagus and can be continuous or patchy.
Pre-malignant/ high grade dysplasia
Young and fit patient:
–endoscopic targeted mucosectomy
-mucosal ablation by epithelial laser, radiofrequency (HALO), or photodynamic ablation
Low grade dysplasia
–annual endoscopic surveillance
No premalignant changes
–surveillance endoscopy + biopsy every 1-3 years
-anti-reflux = high-dose long-term proton pump inhibitors (e.g. omeprazole)
-Patients with long-standing GORD should have one-off screening endoscopies.
–oesophageal cancer (adenocarcinoma)
Prognosis: 0.6-1.6%/yr of those with low grade Barrett’ progress to oesophageal cancer