Barrett’s Oesophagus: Causes, Symptoms and Treatment

Barrett’s Oesophagus

Barrett’s Oesophagus Definition: When columnar mucosa extends at least 3 cm into oesophagus or when it shows intestinal metaplasia, it is described as Barrett’s oesophagus. Ulcer in the Barrett’s CLO is called Barrett’s ulcer.

Barrett’s Oesophagus Pathogenesis: Repeated reflux results in shifting of the esophagogastric junction upwards, which further increases the reflux resulting in intestinal metaplasia of middle and lower oesophagus.

Barrett’s Oesophagus Pathological Types

1. Gastric type with chief and parietal cells.
2. Intestinal type with goblet cells is a marker of intestinal metaplasia. This mucosa is smooth (unlike gastric folds).
3. Junctional type: It has mucus glands and resembles gastric cardia.

Barrett’s Oesophagus Prague Classification: The lower measurement boundary is formed by the proximal cardiac notch (optimally with moderate insufflation), and the two upper measurement boundaries are marked by the proximal limit of the circumferential Barrett’s segment (C) and the longest tongue of Barrett (M).

Read And Learn More: Gastrointestinal Surgery Notes

The circumferential segment (C) is 3 cm and the tongue an additional 2 cm, so that M is 5 cm (3 cm circumferential + 2 cm tongue = 5 cm maximum Barrett’s extent, M). The length of the Barrett is thus C3M5. A short Barrett segment only forming a 1 cm tongue is reported as C0M1. A circular Barrett’s that is 2 cm long without tongues

i.e. with a relatively straight proximal boundary is reported as C2M2.

Barrett’s Oesophagus Clinical Types

1. Long segment: Metaplastic changes involving more than 3 cm.
2. Short segment: Metaplastic changes involving less than 3 cm.

Incidence of Malignancy: 40 times more prone to carcinoma of the lower and middle oesophagus as compared to the general population.

Barrett’s Oesophagus Risk Factors for Carcinoma

• CLO >8 cm o Smoking
• Reflux due to previous gastric surgery
• High grade dysplasia—indication for oesophagectomy

Barrett’s Oesophagus Carcinoma

• It will be invasive
• It is more proximal
• Carries poor prognosis
• 40 times increased risk compared to general population

Types of Dysplasia

1. Low grade: Negligible risk of carcinoma
2. High grade: Very high-risk of carcinoma

Endoscopy And Screening Programme: It is important to screen these patients regularly with repeat endoscopies and multiple biopsies to find dysplasia. Few endoscopy pictures are given here.

Barrett’s Oesophagus Treatment

• High dose proton pump inhibitors for 8 weeks.
• Radiofrequency ablation (RFA) is better than photodynamic therapy and very effective. RFA produce heat and destroys superficial tissue. Ablation pulses of two double pulses of 125/cm².
• Laser photodynamic therapy.
• Argon beam plasma coagulation
• Asymptomatic, symptomatic Barrett’s oesophagus responds well to laparoscopic antireflux surgery. Antireflux surgery also prevents progression to high-grade dysplasia or adenocarcinoma.
• Endoscopic mucosal resection for Barrett’s oesophagus with low-grade dysplasia.
• Oesophagectomy in cases of high-grade dysplasia.

Complications of Barrett’s Oesophagus

1. Oesophageal ulcers: Barrett’s ulcer—pain, bleeding and perforation.
2. Oesophageal stricture: Usually located in the middle or upper oesophagus.
   • Peptic stricture occurs in the distal oesophagus.
3. Dysplasia and adenocarcinoma.

Nonreflux Oesophagitis: This is also a condition which occurs due to several factors such as corrosives, drugs, chemoradiation, AIDS, etc. They are summarised in Table. Basic treatment is similar to that of reflux oesophagitis and avoid the causative agents.

Describe the various symptoms associated with oesophageal disorders.

Describe the various investigations used in evaluation of oesophageal disorders.

Motility Disorders Of  The Pharynx And Oesophagus

Oesophagus Disorders Introduction: Motility disorders of the oesophagus is an important chapter for postgraduate students. There are many classifications. However, Chicago classification has been widely accepted. Few important lesions have been discussed here.

Oesophagus Oesophagus Disorders Classification:

1. Disorders affecting lower oesophagus (oesophagus- gastric junction)
   • Achalasia
   • Diffuse oesophageal spasm
   • Nutcracker oesophagus or Jackhammer oesophagus
2. Disorders affecting upper oesophagus and pharynx
   • Plummer-Vinson syndrome
3. Disorders affecting body
   • Diffuse oesophageal spasm.