Towards screening Barrett’s Oesophagus: current guidelines, imaging modalities and future developments

Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma (OAC). Although guidelines on the screening and surveillance exist in Barrett’s oesophagus, the current strategies are inadequate. Oesophagogastroduodenoscopy (OGD) is the gold standard method in screening for Barrett’s oesophagus. This invasive method is expensive with associated risks negating its use as a current screening tool for Barrett’s oesophagus. This review explores current definitions, epidemiology, biomarkers, surveillance, and screening in Barrett’s oesophagus. Imaging modalities applicable to this condition are discussed, in addition to future developments. There is an urgent need for an alternative non-invasive method of screening and/or surveillance which could be highly beneficial towards reducing waiting times, alleviating patient fears and reducing future costs in current healthcare services. Vibrational spectroscopy has been shown to be promising in categorising Barrett’s oesophagus through to high-grade dysplasia (HGD) and OAC. These techniques need further validation through multicentre trials

Anti reflux surgery

Surgery may be necessary to control gross reflux disease, particularly when anatomical abnormalities underlie the pathophysiology. Treatment is generally less successful when directed at isolated airway reflux and aspiration since the refluxate consists mainly of a gaseous mist which even the tightest ‘wrap’ will not be able to control. When successful however, repeated admissions for recurrent aspiration can be abruptly terminated

O esôfago curto e o refluxo distal são fatores de risco para o refluxo proximal? Short length of the esophagus and distal reflux are risk factors for proximal esophageal reflux?

RACIONAL: Não está claro se pacientes que apresentam refluxo gastroesofágico distal têm maior risco de apresentar também refluxo proximal. O senso comum sugere que um episódio de refluxo poderia chegar mais facilmente à faringe em pacientes que tivessem menor distância a percorrer entre o esfíncter inferior do esôfago e o superior. OBJETIVO: Investigar se o esôfago curto e a presença de refluxo esofágico distal são fatores de risco para refluxo proximal nos pacientes com sintomas respiratórios. MÉTODO: Cento e sete pacientes foram avaliados prospectivamente por meio de entrevista, esofagoscopia, manometria e pHmetria. Utilizaram-se o teste t de Student, o de correlação de Spearman, o do Qui-quadrado e odds-ratio. O nível de significância foi 0,05. RESULTADOS: Os sintomas que motivaram a investigação da doença do refluxo gastroesofágico foram: tosse 43 (40,2%); pigarro 25 (23,4%), globo faríngeo 23 (21,5%) e rouquidão 16 (14,9%). No estudo endoscópico 22 apresentaram esofagite e 14 hérnia de hiato. Na avaliação manométrica 11 (10,8)% apresentaram hipotonia do esfíncter inferior. A média do comprimento do esôfago foi 24,3 (± 1,9) cm, variando de 20 a 30 cm. Na avaliação pHmétrica 23 (21,5%) apresentaram refluxo distal patológico e 12 (11,2%) refluxo proximal. CONCLUSÕES: O comprimento do esôfago não esteve associado com a presença de refluxo proximal. Pacientes que apresentaram refluxo gatroesofágico distal, independente do comprimento do esôfago, tiveram risco aumentado de 4,6 vezes para apresentarem refluxo proximal.<br>BACKGROUND: It is not clear whether patients suffering from distal esophageal reflux also present high risk to proximal esophageal reflux. Common sense suggests that reflux would more easily reach the pharynx in patients who have a smaller distance between the lower esophageal sphincter and the upper one and, thus, short esophagus. AIM: To Investigate if short esophageal length and presence of esophageal distal reflux are risk factors for proximal reflux among patients presenting respiratory symptoms. METHODS: A hundred and seven patients were evaluated prospectively by interview, esophagoscopy, manometry and 24-hour esophageal pH monitoring. Student's t test (two-sided), Spearman's rank correlation, Chi-square and odds ratio were used in the statistical analysis. Significance level was set at 0.05. RESULTS: Respiratory symptoms that motivated the search for gastroesophageal reflux disease were cough 43 (40.2%); throat irritation 25 (23.4%), pharyngeal globe 23 (21.5%) and hoarseness 16 (14.9 %). By esophagoscopy, 22 (27.2%) presented some degree of esophagitis. A hiatal hernia was observed in 14 (17.5%) patients. According to manometry, 11 (10.8%) had lower esophageal sphincter hypotonia. The average esophageal body length was 24.3 (± 1.9) cm, ranging from 20 to 30 cm. The esophageal length was not associated with the presence of proximal esophageal reflux. As indicated by pH monitoring, 23 (21.5%) presented pathologic distal reflux and 12 (11.2%) had proximal reflux. CONCLUSION: The esophageal length was not associated with the presence of proximal esophageal reflux. Patients who had pathological distal esophageal reflux, independent of the esophageal length, were 4.6 times more likely to have proximal esophageal reflux