Barrett’s oesophagus

a change in cell type: from esophageal squamous to specialized intestinal metaplasia

Aetiology: Caused by chronic GE reflux

Epidemiology:

• 10-20% of men scoped for chronic reflux have Barret Oesophagus
• 2% of women have it
• Most common in Caucasian men > 50yrs with long standing (>10yrs) indigestion

Surveillance screening – not supported

Risk factors

1. Inc ing age >40yrs
2. male sex 
3. history of frequent GORD 
4. Abdominal central obesity
5. Smoking

Other: Fhx of oesophageal adenocarcinoma &/or Barrett’s oesophagus 

Associations

Adenocarcinoma (30x  risk)

• risk related to length of Barret oesophagus, presence of hiatal hernia, degree of dysplasia & concurrent smoking
• risk is 0.4%/yr
• Anti reflux medication & surgery will NOT reverse the epithelial changes of barretts or eliminate risk of cancer

Treatment

High grade dysplasia 

1. endoscopic eradication with radiofrequency ablation (RFA) or endoscopic mucosal resection (EMR). Photodynamic therapy is occasionally used.
2. Esophagectomy is an alternative for high grade dysplasia but has higher morbiditiy

Follow up endoscopic surveillance (with biopsy)

As per 2011 ACG guideline:

1. No dysplasia  3-5yrs
2. Low grade dysplasia  6-12 months
3. High grade dysplasia in absence of eradication therapy  3 months