Editing Barrett's oesophagus (section)

== '''Pathophysiology''' ==

* Dysplasia in Barrett's is     characterised by cytologic malignant changes including atypical nuclei,     increased mitoses, and lack of surface maturation
* Dysplasia is most common     closer to GOJ in a long segment of Barrett's
* HGD is distinguished from LGD     by more prominent cytologic or architectural derangements
* Remains dysplasia as long as     it is confined to the epithelium without invasion of the basement     membrane, regardless of the degree of abnormality
* Histological grading is based     on the Vienna classification system - non-dysplastic, indeterminate, LGD,     HGD, intra-mucosal carcinoma
** Lots of intra-observer      variation. In particular, LGD from general pathologists is downgraded to      non-dysplastic by specialist pathologists in 73% of cases
** Indefinite for dysplasia      means equivocal for inflammation or dysplasia - 11.4% pooled annual risk      for progressing to LGD and 0.6% for progression to carcinoma
* Precursor for oesophageal     adenocarcinoma
** Non-dysplastic - 0.3 per 100      person-years
** LGD - 0.5
** HGD - 6.6
** Overall incidence of      oesophageal adenocarcinoma in BE patients is about 40x the general      population
* Long segment is >=3cm -     significantly higher risk of progression to carcinoma
* Short tongues     <1cm/'variable Z-line' were previously called ultra-short segment     Barrett's, but do not constitute increased malignancy risk and no need to     biopsy if no concerns for dysplasia