World Barrett's Day is the 16th May, the birthday of Norman Barrett who the condition is named after.
Who was Norman Barrett?
Barrett’s oesophagus is named after Norman Barrett born on May 16, 1903 in Adelaide, Australia.Norman moved to England at the age of 10 and was educated at Eton College and Trinity College, Cambridge.
He trained at St. Thomas 'Hospital and graduated in 1928. He continued as a resident assistant surgeon at St. Thomas' Hospital and was elected to the Royal College of Surgeons in 1930.
Initially he thought Barrett’s oesophagus was found in patients born with a “short oesophagus”, with the stomach pulled up into the chest.
Later research led to the knowledge that Barrett’s oesophagus was a condition you could develop where the lining of the lower oesophagus could change to become similar to that found later on in the intestine.
What is Barrett's Esophagus?
Barrett's Esophagus, a lining of new cells in the lower esophagus can form as a protection against frequent attacks of acid refluxing from the stomach. However, these cells have the ability to mutate to esophageal adenocarcinoma, a particularly virulent cancer with poor prognosis.
The risk is small and Barrett's is manageable. However, Barrett's itself has no symptoms and the cancer is too frequently diagnosed when it's too late to treat.
How common is it?
This chart aims to show incidence and risk:
The diagram above represents the total population.
If applied to USA, each square of the graph paper represents 2500 people.
If applied to UK, each square of the graph paper represents 1000 people.
Most people, the 60% to the left of the chart, do not experience acid reflux but 40% do.
Of those, half (about 20% of the population) experience it frequently, when it's known as GERD.
Of those with GERD (although some claim not to have felt it), some will develop Barrett's.
The column on the right shows all those with Barrett's (about 5% of the population).
Most people with Barrett's do not know it. Those who do are represented by green squares.
Some will die of esophageal adenocarcinoma. They are represented by red squares.
Although shown as separate groups, it is possible that some who know they have Barrett's may die from the cancer but surveillance and medication reduce that risk.
These sources were used in the preparation of the chart:
Prevalence of Barrett's from Controversies in Barrett Esophagus from Mayo Clinic
Definition and facts for GERD from National Institute for Diabetes and Digestive and Kidney Diseases
Lifetime risk of esophageal adenocarcinoma in patients with Barrett's Esophagus from UK Barrett's Regsitry (UKBOR)
At present, Barrett's is diagnosed by putting a long thin camera, known as an endoscope, down the throat and a pathologist assessing any biopsies taken. This can mean, those not considered high risk (typically overweight middle aged white males) may go undiagnosed. New technologies are becoming available which will make earlier detection easier.
Those diagnosed are recommended to take daily acid suppressant drugs indefinitely and have regular surveillance endoscopy every few years to look for any pre-cancerous changes which, if seen, can be removed by ablation therapy.
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