Complex Benign Diseases
There are a number of complex benign (non-cancerous) upper GI conditions that may either lead to cancer or require treatment via revisional surgery or other interventions. This section provides some information on the following:
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Barrett's Oesophagus
Barrett’s oesophagus is a pre-cancerous condition and is defined by biopsy evidence of columnar oesophageal epithelium with specialised intestinal metaplasia just before the gastro-oesophageal junction (GOJ). This columnar epithelium resembles that in the stomach and intestine. This needs to be confirmed on 2 separate endoscopies.
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The risk of carcinoma relates to the length of Barrett’s, and other risk factors including age, obesity, smoking.
There is a well-established surveillance programme for Barrett’s oesophagus in the UK, where biopsies are taken to assess for any abnormal cells (dysplasia). For people with Barrett’s oesophagus less than 3cm in length, they undergo 5-yearly surveillance. For people with Barrett’s oesophagus greater than 3cm in length, they undergo 3 yearly surveillance.
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If there is presence of dysplasia, the UK guidance is for recommendation to offer endoscopic treatment. This therapy aims to destroy the Barrett’s epithelium, leaving a surface that is subsequently replaced with a normal squamous epithelium.
Achalasia
Achalasia is an acquired condition in which muscles of the oesophagus (gullet) stop working properly. As a result, the muscle (or valve) at the bottom of the oesophagus does not open enough after swallowing to allow food to pass into the stomach. Achalasia affects 1 in 100,000 people in the UK, usually between the ages of 30 and 60. The exact cause is unknown, but it thought to be due to loss of certain nerve cells in the muscle layer of the oesophagus.
Patient report symptoms of food sticking in the throat (dysphagia), vomiting or regurgitation of food (usually undigested), chest pain, or food going down the windpipe (trachea) into the lung, which can cause coughing, infection and potentially pneumonia.
Diagnosis tests for achalasia are covered in the Diagnosis section and its treatment is covered in the endoscopic interventions section and surgical treatments section,
Gastro- Oesophageal Reflux
Many people suffer with reflux symptoms, with reflux of the stomach contents causing troublesome symptoms, and that can affect their quality of life. Majority will have symptoms controlled with lifestyle modifications such as anti-acid medication, avoiding triggering foods, and weight loss. However, some do not want to take medications for the rest of their life, or they might have giant hiatus hernias which are symptomatic and can cause a mechanical obstruction.
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Diagnosis tests for achalasia are covered in the Diagnosis section and its treatment is covered in the surgical treatments section.