Barrett's Oesophagus

What is Barrett's oesophagus?

Barrett's oesophagus is the change in the inner lining of the lower gullet from the pale pink (squamous) cells to the bright pink (columnar) cells. This cell change is referred to as metaplasia. It results from longstanding damage from stomach acid and bile which reflux and burns the inner lining of the lower gullet. It is found in about 1 in 10 (10%) of those with chronic acid reflux but overall is found in 1% of UK population.


Is there any risk associated with having Barrett's oesophagus?

Barrett's oesophagus is one of the precursors of cancer of the gullet whose incidence has increased about 2 - 3 fold in the last two decades. The risk of progression of Barrett's oesophagus to cancer depends sometimes on the degree of abnormal cell changes which can be present well before cancer develops. This abnormal cell changes are referred to as dysplasia, ranging from the no dysplasia, low grade dysplasia to high grade dysplasia with greatest risk of cancer being associated with high grade dysplasia. 
Although the risk of someone with Barrett's oesophagus developing gullet cancer is increased about 44 times compared to someone without Barrett's oesophagus, in real terms this risk is very small and is less than 1%. Most people with Barrett's oesophagus will die from causes other than gullet cancer.


Are there any specific symptoms of Barrett's oesophagus?

There are no specific symptoms attributable to Barrett's oesophagus. Most people will experience the usual symptoms of acid reflux and will only be diagnosed with Barrett's oesophagus when they have camera examination of the gullet and stomach known as gastroscopy. In other patients, there will be no symptoms of acid reflux such as heartburn because a gullet affected by Barrett's changes, tend to be insensitive to acid burns. The Barrett's changes in these situations are only detected incidentally when the individual concerned have gastroscopy for other conditions affecting the upper gastrointestinal tract.


How is Barrett's oesophagus managed?

Managing Barrett's oesophagus involves a number of approaches which include

  • Lifestyle changes - things you can do to help include losing any excess weight, avoiding going to bed with full stomach, stopping smoking.
     
  • Drug treatment - full doses of acid-suppressing medications are required on a daily basis to suppress stomach acid production and therefore minimise the ongoing damage to the internal lining of the lower gullet. There are various types available and they are similarly effective in suppressing acid production. They may be combined with over-the counter antacids for better symptomatic relief. These medications do not reverse the changes in Barrett's oesophagus and they are not known to change the natural progression of Barrett's oesophagus. The same is applicable to anti-reflux surgery.
     
  • Surgery - Anti-reflux surgery can be performed to stop the reflux of stomach contents including bile salts into the lower gullet. The surgery reinforces the weak lower gullet valve which acts as a mechanical barrier to stop further acid and bile reflux. It is successful in over 90% of patients and your surgeon should discuss with you in detail whether this is the right option for you or not. It is performed using the keyhole technique which minimises the pain and discomfort of the surgery and recovery is quicker with early return to normal physical activities. Surgery to remove the gullet may be indicated if the abnormal cell changes have progressed to high grade dysplasia in those who are fit for surgery because the incidence of undiagnosed (usually early) cancer of the gullet is as high as 40%. If the cancer is detected early the chances of a cure are very high but the decision to perform such a high risk surgery under these circumstances would need independent confirmation from another pathologist and should be discussed in a multi-disciplinary team setting. Other forms of treatment for Barrett's oesophagus include photodynamic therapy (PDT) and endoscopic mucosal resection (EMR). For those whose Barrett's oesophageal (gullet) cancers are detected late, the treatment is only palliative and the prognosis is usually poor. It is therefore advisable to monitor Barrett's oesophagus to help with early detection of abnormal cell changes which may progress to cancer. This is usually done by regular check-ups using upper gastrointestinal endoscopy, also known as gastroscopy.
     
  • Endoscopy - Approximately 5-10% of people with Barrett's oesophagus will go on to develop cancer of the gullet. It is for this reason that regular check-ups are advised in the form of upper gastrointestinal endoscopy. This is an internal examination of the gullet and stomach using a small flexible camera which also enables sampling of the Barrett's segment for further microscopic examination. This microscopic examination of the cells helps to detect any abnormal changes in the cells that may indicate progression to cancer. It is usually performed as a day case and may involve a light relaxing sedative to make the procedure less uncomfortable for the patient. The frequency of the camera test will be discussed in detail with you at your consultation with your surgeon and depends on the degree of abnormal cell changes (dysplasia) detected when Barrett's oesophagus is first diagnosed. 


Want to find out more?

If you suffer from chronic acid reflux symptoms such as heartburn, regurgitation of tasteless fluid into your throat and mouth on minimal straining and other indigestion symptoms and would like further information, please telephone 0161432 2061 or email info@surgicalcarespecialists.co.uk