Barrett's oesophagus

Question 1

What is Barrett’s Oesophagus?

Answer 1

Metaplasia of normal squamous epithelium to abnormal columnar epithelium containing intestinal metaplasia.

Question 2

Aetiology of Barrett’s?

Answer 2

Thought to be long standing GORD with subsequent damage to squamous epithelium.

Question 3

Epidemiology of Barrett’s?

Answer 3

• Males (more common)
• > 50
• Caucasians
• Smokers
• Overweight
• hiatus hernia
• long standing reflux symptoms

Question 4

Endoscopic findings in BE?

Answer 4

Erythematous epithelium in distal oesophagus; diagnosis requires biopsy.

Question 5

Pathophysiology of BE?

Answer 5

BE predisposes to premalignant changes in abnormal columnar epithelium (characterised as low or high grade dysplasia)

Question 6

Management of BE?

Answer 6

• High dose PPI indefinitely
• No dysplasia: endoscopy 3yrly
• Low grade: surveillance and endoscopic ablation / resection
• High grade: regular and frequent surveillance with intensive biopsy, endoscopic ablation/resection or oesophagectomy.