Barrett's Oesophagus

Barrett’s oesophagus is a condition that occurs when the lining of lower portion of the oesophagus become similar to the lining of the stomach or small intestine. Instead of the cells being like skin cells, they are like those found in the lining of the stomach. Barrett’s oesophagus was first identified by Norman Barrett, a surgeon, in the 1950’s.

Barrett’s oesophagus is not a common condition, but it is fairly common among people who suffer from chronic acid reflux. It is estimated that around 1 in 100 people with long-term reflux develop Barrett’s oesophagus. The condition tends to affect people over the age of 50 and is more common in men than women.

What causes Barrett’s oesophagus?

The exact cause of Barrett’s oesophagus is unknown, though doctors believe it is linked to reflux, which occurs when acid from the stomach goes back up the oesophagus. Acid is produced to help with digestion and a sphincter muscle in the oesophagus usually prevents reflux by closing once food has passed through the gullet.

However, if the ring of muscle does not work properly, acid may come back up.

The oesophagus does not have a protective lining, so recurrent bouts of reflux can cause the gullet to become inflamed (known as oesophagitis) and damaged. Sometimes, contents from the duodenum, including bile, can also mix with the stomach acids and this can be even more damaging than acid alone. The oesophagus can usually recover very quickly from occasional bouts of acid reflux, but if it does not heal properly this can cause changes in the lining, so that it resembles the lining of the stomach.

The abnormal cells in the lower section of the oesophagus are not cancerous but they have a higher risk of becoming cancerous than other cells in the oesophagus, as these cells have something called dysplasia. There are high and low grades of dysplasia, with high grade dysplasia cells carrying a higher risk of becoming cancerous. Around 1 in 20 people with Barrett’s oesophagus develop low-grade dysplasia, while between 1 and 5 in 10 people develop high grade dysplasia or oesophageal cancer within 2-5 years of diagnosis.

Symptoms of Barrett’s oesophagus

In many cases, Barrett’s oesophagus does not cause symptoms and, for this reason, it is often diagnosed as part of investigations on patients who have symptoms of digestive conditions (usually gastro-oesophageal reflux), including heartburn. Other possible symptoms include:

• A salty taste in the back of the mouth (known as water brash).
• Hoarseness.
• Chest pain.

Complications of Barrett’s oesophagus

It is uncommon for people with Barrett’s oesophagus to develop complications, but it is possible. Complications of Barrett’s oesophagus include:

• Ulcers in the oesophagus.
• Cancer (this is rare).
• Bleeding.
• Problems with swallowing (this is caused by narrowing of the oesophagus).

How is Barrett’s oesophagus diagnosed?

Barrett’s oesophagus is usually diagnosed following an endoscopy. An endoscopy requires the use of a thin flexible tube (known as an endoscope) with a camera attached to allow doctors to see the inside of the oesophagus. The endoscope is passed through the mouth, down the throat and into the oesophagus. If your doctor suspects that you have Barrett’s oesophagus after the endoscopy, they will take biopsies (samples of tissue) from the lining of the oesophagus to be analysed at the laboratory.

Treating Barrett’s oesophagus

There are three main treatment options for Barrett’s oesophagus. However, at the moment it is unknown which is most effective and research is ongoing. Treatment for Barrett’s oesophagus involves:

• Treating acid reflux.
• Watchful waiting and monitoring.
• Treating symptoms.

Treating acid reflux: acid reflux occurs when acidic juices from the stomach go back up the oesophagus. Usually, once food passes down the gullet the sphincter muscle closes, preventing the acid from coming back up. Reflux is not usually a serious problem but it causes unpleasant symptoms, including heartburn and a disagreeable taste in the mouth. Treatment for reflux includes medication to suppress acid production and it is likely that your doctor will prescribe medication on a long-term basis if you have recurrent reflux. If the sphincter muscle is damaged or weakened, it may be necessary to repair it by means of a surgical procedure.

Watchful waiting: if you do not experience symptoms doctors may adopt a policy of watchful waiting or surveillance, which will require regular tests to check for signs of dysplasia. Dysplasia causes cells to be abnormal and, although they are not cancerous, they have a higher risk of becoming cancerous and are often referred to as pre-cancerous. If dysplasia cells are detected your doctor will probably advise you to have biopsy and endoscopy tests every 3-6 months. Treating symptoms: there are some things you can do to try and reduce the symptoms of reflux, which usually involves lifestyle changes, including losing weight (if this is applicable), stopping smoking, avoiding eating at night and swapping three big meals for 5 or 6 small meals.

Will I need further tests?

If you are diagnosed with Barrett’s oesophagus, you will be advised to attend your doctor on a customary basis. If you develop symptoms, including unexplained weight loss, problems with swallowing or vomiting blood, you should see your doctor as soon as possible. These symptoms may be linked to possible complications of Barrett’s oesophagus and it is important that you are checked out; this is because, in rare cases, the condition can increase the risk of cancer of the oesophagus.