Related Subjects:
| Achalasia
| Oesophageal Carcinoma
| Diffuse Oesophageal spasm
| Diffuse Oesophageal Perforation - Rupture
| Gastro-Oesophageal Reflux
| Barrett's oesophagus
It is a premalignant condition that may evolve into oesophageal adenocarcinoma and is associated with GORD/GERD
Flat cells elongate
Reprogrammed, a change of fate
Acid splashes burn
Battered, scarred, loss of order
Scarlet tongues GE border
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About
- Barrett’s oesophagus is defined as an oesophagus in which
any portion of the normal distal squamous epithelial lining
has been replaced by metaplastic columnar epithelium
- It is clearly visible endoscopically (=1 cm) above the GOJ and
confirmed histopathologically from oesophageal biopsies
Aetiology
- Barrett's oesophagus is caused by Gastro-oesophageal reflux disease
- This causes metaplasia such that the normal squamous epithelium is replaced by tall glandular columnar cells
- Male gender, older age and history of reflux symptoms are the main established predictors of increased risk
of Barrett’s oesophagus
Risk factors
- GORD symptoms
- Male sex, Age over 45
- Length over 8 cm
- Early onset
- Ulceration or Stricture
Investigations
- OGD - the grey and pale normal squamous appearance is replaced by pink columnar epithelium
- Biopsy may be performed to confirm and look for dysplasia or carcinoma. Multiple biopsies are taken as the dysplasia can be patchy. Biopsies usually taken 2 cm apart.
- An Indocarmine spray can help spot dysplastic changes seen through the endoscope
Management: NICE
- Offer high resolution white light endoscopic surveillance with Seattle protocol biopsies:
- every 2 to 3 years to people with long-segment (3 cm or longer) Barrett's oesophagus
- every 3 to 5 years to people with short-segment (less than 3 cm) Barrett's oesophagus with intestinal metaplasia.
- Assess a person's risk of cancer based on their age, sex, family history of oesophageal cancer and smoking history and tailor the frequency of endoscopic surveillance accordingly, within the intervals given in recommendation
- Do not offer endoscopic surveillance to people with short-segment (less than 3 cm) Barrett's oesophagus without intestinal metaplasia provided the diagnosis has been confirmed at 2 endoscopies.
- Traditional treatment is with high dose Proton pump inhibitors though there is no real evidence that they make much difference
- Patients with a diagnosis of indefinite for dysplasia should be
managed with an optimisation of the antireflux medical therapy
and re-endoscoped in 6 months. If no definite dysplasia is found on
subsequent biopsies, then the surveillance strategy should follow
the recommendation for non-dysplastic Barrett’s oesophagus
- Oesophagectomy in some cases. See algorithm below.
References