What is Barrett’s oesophagus?

Barrett’s Oesophagus is a condition where the normal lining, coating the lower part of the gullet (oesophagus) changes to being a different lining which is more like than found in the stomach or intestine. This condition was named after a London surgeon called Norman Barrett in the 1950’s. He was among the first to discover it.

What causes Barrett’s Oesophagus?

The cause of the condition is not known. It is believed that many years of reflux of stomach contents into the gullet (sometimes perceived as heartburn) causes injury to the lining of the gullet (oesophagitis). This inflammation may lead to damage to the gullet cells, causing the change we call Barrett’s Oesophagus. Sometimes bile-containing juices in the small intestine may work their way backwards into the stomach and gullet. It is possible that this mixture of stomach and intestinal juices is more damaging to the gullet than acid alone.

In normal circumstances the gullet heals and returns to normal, but sometimes the gullet does not heal in the usual way. How or why this change happens is not known. It appears that this change may be more common in patients who are male gender, and/or overweight. It has been shown that smoking can accelerate any change in Barrett’s Oesophagus. The ‘Western’ diet of high fats and carbohydrates may be implicated too.

What are the usual symptoms?

The condition often has no symptoms, but Barrett’s oesophagus is sometimes found when a person is examined by means of an endoscopy for symptoms of heartburn and acid indigestion.
Sometimes Barrett’s oesophagus is found in people undergoing endoscopy for some other reason, e.g. to investigate anaemia. Other rare associated symptoms may include – hoarse voice,
chronic cough, painful swallowing or food sticking after it has been swallowed.

What are the complications?

Barrett’s Oesophagus can rarely cause a complication. Possible complications include:- Ulcers in the gullet, painful swallowing, difficulty swallowing, narrowing of the gullet
or rarely, cancer of the gullet Oesophagus). Luckily, most patients with Barrett’s Oesophagus will never experience any of the above complications.

Is Barrett’s Oesophagus important?

Cancer of the Oesophagus (gullet) develops in up to 5% of patients with Barrett’s Oesophagus during the course of their lifetime. This means that 19 patients in every 20 with Barrett’s oesophagus will never develop oesophageal cancer.

Cancer of the Oesophagus can take many years to develop and is often preceded by abnormal cell changes within the lining of the gullet (called dysplasia). Often patients are invited to undergo endoscopy at regular intervals to identify dysplasia. If these changes are detected early, then pre-cancerous changes can sometimes be cured.

Nonetheless it remains unclear how beneficial these regular examinations of the gullet are, because so few patients will go on to develop a complication. Moreover there is no guarantee that having regular endoscopies will detect cancer of the oesophagus at a curable stage. Rarely cancers can develop between one surveillance endoscopy and the next one.

It will be some years before the advantages and disadvantages of regular endoscopies become clear. Also endoscopy is not without its own risks, and these are themselves higher in older patients and/or those with major cardiac or chest diseases.

What is the treatment?

Treatment is usually aimed at reducing acid heartburn, controlling the symptoms and preventing any complications. Normally this is achieved by drug treatment (proton pump inhibitor medications), but occasional patients are investigated with a view to surgery to strengthen the junction between the stomach and gullet (anti-reflux or fundoplication surgery). Newer treatments for dysplasia, include radiofrequency ablation and endoscopic removal of small nodules.

You can take these helpful measures to reduce acid reflux.

  • Stopping smoking
  • Losing weight – if overweight
  • Limiting your intake of fatty food, chocolate and caffeine
  • Reducing intake of spicy foods and citrus fruits, if they aggravate the gullet or cause heartburn
  • Trying not to eat large meals especially late at night or just before bed time
  • Avoid over-filling the stomach with large drinks
  • Sleeping in a more upright position, if heartburn is worse at night

Medication

Patients with Barrett’s Oesophagus are normally treated with lifelong daily medication. This medication aims to reduce the amount of acid the stomach can make, so as to reduce the risk of acid refluxing into the oesophagus (gullet). The common medication used is called a Proton Pump Inhibitor (PPI). (e.g. Omeprazole or Lansoprazole) The exact dose can vary with brands and doses being modified until symptoms are controlled. Recent trials have suggested that high dose PPI with aspirin can reduce the progression of Barrett’s oesophagus to dysplasia or cancer.

Surveillance endoscopies

If you have Barrett’s oesophagus, you should consider whether you should have the condition checked at regular intervals. This is known as surveillance and usually involves regular endoscopies and biopsies.

There are benefits and disadvantages of surveillance. The benefits include potentially catching dysplasia or cancer at an earlier and more treatable stage (i.e. when it might be highly curable). However, this cannot be guaranteed as these changes could appear between endoscopies. Disadvantages include the risks and inconvenience of regular endoscopy and the general worry about having frequency procedures.

You may have endoscopies at intervals ranging from every three months to every three years. This will depend on whether your condition is changing, the degree of change and your hospital’s policy. You may find it helpful to discuss this with your specialist. The aim of surveillance is to find early changes (dysplasia) that may develop into cancer. Treatment can then be given to prevent cancer developing. Sometimes surveillance finds cancer in the very early stages, when treatment can be given to cure it.

If you are having regular endoscopies and notice any changes or your symptoms get worse between appointments, contact your specialist.