Globus phryngeus

A clinical syndrome associated with a sensation of a lump in the throat in the absence of physical abnormality, and is usually of psychogenic origin.

Barrett's oesophagus

Barrett's refers to the metaplasia of the lower oesophageal mucosa, with the usual squamous epithelium being replaced by columnar epithelium. There is an increased risk of oesophageal adenocarcinoma, estimated at 50-100 fold.

Though, total risk of CA in Barrett patients is low (about 0.4%)

Histological features

• the columnar epithelium may resemble that of either the cardiac region of the stomach or that of the small intestine (e.g. with goblet cells, brush border)

Management

• endoscopic surveillance with biopsies *
• high-dose proton pump inhibitor
• Recommendation:

Barrett esophagus without dysplasia, do two consecutive examinations within a year, with screening examinations every 3 years thereafter

low grade dysplasia needs to repeat endoscopy at 3 to 6 months

high grade dysplasia should have a distal esophagectomy or an endoscopic mucosal resection

Rings and Webs

Schatzki ring and Plummer-Vinson syndrome both give dysphagia (but NOT progressive as in achalasia or carcinoma)

Schatzki ring

• from acid reflux - kind of scarring or tightening (a.k.a peptic stricture) of the distal esophagus

Plummer-Vinson $