f Post graduate mcqs and discussion : BARRETT’S OESOPHAGUS

Monday, March 26

BARRETT’S OESOPHAGUS

  It is the metaplastic changes in the mucosa of the oesophagus as the result of gastroesophageal reflux disease.
Squamous epithelium of lower end of the oesophagus is replaced by diseased columnar epithelium (columnar metaplasia).

Fig: Barret oesophagus 


There is macroscopic visible length of columnar mucosa with microscopic features of intestinal metaplasia.
 It affects lower oesophagus commonly and often middle oesophagus also.

Types (Based on Length) :

a. If the length of metaplasia is more than 3 cm, it is called as long segment Barrett’s oesophagus—classic Barrett type.

 b. If the length is less than 3 cm, it is called as short segment Barrett’s oesophagus.

Histological Types :

a. Gastric type: Contains chief and parietal cells.

 b. Intestinal type: Contains goblet cells.

c. Junctional type: Contains mucous glands alike of gastric cardia.

Cardia(parts of stomach )  metaplasia is metaplasia at Oesophageal-Gastric  junction without any macroscopic change in gastroscopy.


This diseased columnar epithelium is more prone for malignant transformation, i.e. when there is intestinal metaplasia, risk of malignant transformation increases. More the amount of dysplasia more is the risk of malignant transformation. Dysplasia may be indefinite; low grade or high grade.


Clinical Features :

Features of Gastroesophageal reflux disease
Haematemesis.
Common in men; common in whites.


Complications of Barrett’s oesophagus:

Ulcerations and stricture
Dysphagia
Bleeding
Perforation
Adeno-carcinoma of Oesophageal-Gastric junction (25 times more common)



Management :

Regular endoscopic biopsy and surveillance for low grade dysplasia.

Ablation of Barrett’s oesophagus by laser.

Photodynamic therapy—through endoscopy.

Argon beam coagulation.

Proton pump inhibitors—high dose for 3-6 months.


Antireflux treatment by surgery.

Resection—Always better choice—for high grade dysplasia. Transhiatal oesophagectomy is preferred. 

Endoscopic mucosal resection.