Upper GIT pathology

Page 1

Barrett's oesophagus:

long-term consequence of reflux

metaplasia from squamous to columnar epithelium

increased risk of oesophageal carcinoma

epithelial dysplasia precedes malignancy

Regular surveillance by biopsy recommended

The endoscopist sees proximal extension of salmon-coloured 'tongues' of mucosa replacing the usual pearly white squamous epithelium, which can expand to a complete cylinder of columnar epithelium occupying much of distal half of the oesophagus.

Histologically - intestinal metaplasia and consists of columnar epithelium with goblet cells and tall intervening mucous producing cells, both secreting intestinal type mucins.

Thought to arise in response to adverse micro-environment (acid reflux) and can be regarded as a defensive response in which the new cell lineage (columnar epithelium) has survival advantage over the 'native' epithelium it has replaced.

Have higher risk of developing oesophageal adenocarcinoma than the general population. Overall small risk, currently best practice to undertake regular endoscopic surveillance once Barrett's oesophagus has been diagnosed.