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Upper Gastrointestinal Tract Pathology Quiz
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Which pathological change best defines Barrett’s oesophagus?
- A Congenital presence of columnar epithelium throughout the oesophagus You picked ✕
- B Acute inflammatory damage to the oesophageal mucosa caused by acid reflux You picked ✕
- C Replacement of normal squamous epithelium with columnar epithelium in the distal oesophagus You picked ✓
- D Hyperplasia of oesophageal glands in response to chronic irritation You picked ✕
- E Malignant proliferation of glandular-type cells in the distal oesophagus You picked ✕
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Incorrect
The answer is C: Replacement of normal squamous epithelium with columnar epithelium in the distal oesophagus
Explanation
Why C is correct
See Barrett's Oesophagus. Option C is correct because Barrett's oesophagus is defined by replacement of the normal stratified squamous epithelium of the distal oesophagus with metaplastic columnar epithelium. Metaplasia means one mature cell type changing into another, and here it is an adaptation: chronic exposure to stomach acid causes the lining to switch to a type that tolerates acid better. It develops during the healing phase of acute oesophagitis (inflammation of the oesophageal lining) in people with long-standing reflux, and risk factors include increasing age, male sex, abdominal obesity and acid reflux. Barrett's oesophagus itself is not cancer, but it is a pre-malignant condition because the new lining is prone to dysplasia (disordered growth) and then to adenocarcinoma, so patients are offered endoscopic surveillance. Remember the sequence of reflux, then metaplasia, then dysplasia, then adenocarcinoma.
- Definition: The stratified squamous epithelium of the distal oesophagus is replaced by metaplastic columnar epithelium.
- Cause: Chronic exposure to stomach acid in long-standing reflux.
- Risk: It is pre-malignant, because the new lining is prone to dysplasia and then adenocarcinoma.
Why the other options are incorrect
- A. Congenital presence of columnar epithelium throughout the oesophagus: Barrett's oesophagus is acquired after long-term reflux, not present from birth. A congenital columnar lining would be a developmental condition. It would be correct for a question about a congenital abnormality of the oesophagus. Your answer
- B. Acute inflammatory damage to the oesophageal mucosa caused by acid reflux: Acute inflammatory damage to the mucosa from acid is oesophagitis. It is a change in inflammation, not a change in the type of lining. It would be correct for a question about reflux oesophagitis. Your answer
- D. Hyperplasia of oesophageal glands in response to chronic irritation: Hyperplasia is an increase in the number of cells, and it does not describe the switch from squamous to columnar lining that defines Barrett's. It would be correct for a question about glandular overgrowth without a change in lining. Your answer
- E. Malignant proliferation of glandular-type cells in the distal oesophagus: Malignant proliferation of glandular cells is adenocarcinoma, which is the cancer that Barrett's oesophagus predisposes to. Barrett's itself is not malignant. It would be correct for a question about oesophageal adenocarcinoma. Your answer
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