Barrett’s Oesophagus

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.


Barrett’s Oesophagus

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

Image result for barrett's oesophagus

Epidemiology:

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

Investigations:

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.

Image result for barrett's oesophagus

 

Image result for barrett's oesophagus biopsy histology

Management:

Pre-malignant/ high grade dysplasia

Young and fit patient:

oesophageal resection

-eradicative mucosectomy

Others:

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.

 

Complications:

oesophageal cancer (adenocarcinoma)

Prognosis: 0.6-1.6%/yr of those with low grade Barrett’ progress to oesophageal cancer

References: Cheese & Onion, BMJ best practice
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