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Heartburn may occur when the muscles at the lower end of your oesophagus – also known as your gullet or foodpipe – become weak and allow digestive juices from your stomach and small bowel to flow back up. This is called reflux.

This causes the typical burning pain in your chest, hence the name heartburn. The pain may rise and spread to your throat and jaw.

If you find it difficult or painful to swallow, have symptoms of anaemia – that is feeling permanently tired, dizzy or faint – or have unexplained weight loss you should consult your doctor straight away.

Your doctor may refer you to a hospital for further investigation. Barrett’s Oesophagus is diagnosed by an endoscopy and a biopsy.

An endoscopy involves having a very narrow flexible tube passed into your gullet. The tube contains a tiny camera that can relay back images of your gullet and stomach so that the doctor can observe whether the tissue looks normal. You may be sedated and your throat may be anesthetised. You will be able to breathe normally.

The procedure is backed up by a biopsy taken at the same time, where a small sample of the tissue in your gullet is removed and then examined under a microscope.

From the information that is gathered the doctor can diagnose whether you have Barrett’s Oesophagus.

Most treatments for Barrett’s Oesophagus aim to reduce the acid and bile reflux and control symptoms.

What you can do

• • If your heartburn is worse at night, avoid eating large meals in the evening. Raise the head of your bed so that your head is higher than your stomach.

  • If you are a smoker, quit.

  • Reduce or cut out alcohol and caffeine.

  • Avoid foods that you know trigger your heartburn, for example, fatty foods, chocolate, citrus fruit, spicy foods.

  • If you are overweight, try to lose weight.

Drug treatment

You will usually be given tablets to lower the acid content of your stomach. The most common are called proton pump inhibitors. They will control the heartburn and should stop your oesophagus becoming inflamed. You will probably need to take these tablets permanently.

If your symptoms are worse at night you may be given an acid suppressor like ranitidine (Zantac).

Surgical treatment

You may have surgery recommended to strengthen the weak valve at the lower end of your oesophagus, especially if you suffer from bile backing up, which is less easy to control with tablets.

This surgery is called a Fundoplication and can be done as a keyhole (laparoscopic) procedure. This usually stops the reflux of acid or bile.

However, as with all operations, there are benefits and risks and this treatment is not recommended for everyone It is important to discuss the options with your surgeon.

Regular check-ups

If you have been diagnosed with Barrett’s Oesophagus regular check-ups will be recommended to have both an endoscopy and a biopsy. How often you have these check-ups will depend; your doctors may want to see you several times a year, or may feel that every two years is sufficient. These regular checks will allow them to monitor any changes in the cells of your oesophagus and to alter your treatment as necessary.

Treatments to prevent cancer

Since the vast majority of patients with Barrett’s Oesophagus do not get cancer, the usual practice is not to attempt to remove the Barrett’s cells. Treatment is usually only offered if the cells look as if they are starting to change in a way that suggests a worsening of the condition. These cellular changes are called dysplasia.

What happens if dysplasia is found?

If the pre-cancerous cell changes are detected within the Barrett’s lining, the endoscopy and tissue sampling are repeated more frequently – generally six-monthly for low grade dysplasia or three-monthly if high grade dysplasia is found.

If the endoscopy and tissue sampling show high grade dysplasia, and particularly if it is found in several of the biopsies, then treatment is recommended. High grade dysplasia is strongly associated with cancer of the gullet and early treatment can potentially prevent the risk of cancer.

All people with high grade dysplasia should be referred to a specialist centre where their case is discussed by a multi-disciplinary team of doctors . All treatments will aim to remove the dysplasia.

Some experts believe that patients should have an operation to remove the gullet, called an oesophagectomy. Others believe that surveillance through endoscopies at regular intervals is sufficient and that an operation should be reserved for patients who have developed cancer.

An oesophagectomy is major surgery and usually involves opening both the stomach and the chest. It takes some months for people to return to full health. Surgery is therefore not generally recommended for patients with declining health or for those who are too weak to withstand a major procedure.

Alternative treatments involve removing the abnormal Barrett’s lining during an endoscopy. Procedures include:

Epithelial Radio Frequency Ablation for Barrett’s Oesophagus

An electric wire is inserted into the oesophagus and burns away dysplasia.The Barrx™ RF Ablation System uses this technique for treating Barrett's Oesophagus.

Photodynamic therapy (PDT)

A drug is given to make the Barrett’s cells sensitive to light. A light is then inserted into the oesophagus and burns off the Barrett’s tissue.

Endoscopic Mucosal Resection (EMR)

If only a small area of the Barrett’s lining is affected by dysplasia this may be removed by a suction and snare procedure performed during an endoscopy. In this, suction is used to lift the Barrett’s tissue off the wall of the oesophagus. A wire snare is passed down the endoscope, looped over the tissue and tightened. The snare is then heated, which releases the tissue and seals blood vessels to minimise bleeding (electrocoagulation).

Laser therapy. Barrett’s cells are destroyed by a laser probe inserted in the oesophagus. This is effective but difficult to apply evenly.

Argon plasma coagulation. A jet of argon gas is released into the gullet along with an electric current that burns away dysplasia.

These procedures are usually combined with strong doses of acid lowering tablets, also called proton pump inhibitors, to try to ensure that the abnormal lining does not regrow.

Most people with Barrett’s Oesophagus suffer nothing other than heartburn. A few people may get inflamed ulcers in their oesophagus.

Barrett’s ulcers

These are due to a breakdown in the gullet lining. You may experience:

• • chest pain

  • pain swallowing

  • unusual stools – black, tarry or bloody

  • vomiting red blood or blood that looks like coffee grounds

  • symptoms of anaemia such as lethargy

Barrett’s ulcers are diagnosed by endoscopy. This means using a tiny camera to examine your gullet and stomach. Treatment may include increasing your acid lowering medications or surgery to prevent reflux of acid. If you are anaemic this may be treated with iron tablets or a blood transfusion.

Stricture

This is a narrowing in the gullet that may cause:

• • difficulty swallowing (dysphagia)

  • an unexpected drop in weight

If you develop these symptoms you should see your doctor.

A stricture may be diagnosed by performing an endoscopy or a barium swallow. In a barium test you drink a dense liquid called barium and X-rays are taken as it passes through your gullet and stomach.

Strictures are treated by stretching the narrowed gullet. This involves an endoscopy, usually under X-ray control, and then a tube or balloon is passed down to stretch the gullet. It is also necessary to reduce your acid reflux to prevent the stricture reforming. This is achieved by increasing your dose of acid lowering medications or occasionally by surgery.

Pre-cancerous change (dysplasia)

In a very small number of patients Barrett’s Oesophagus can gradually lead to cancer of the gullet or upper stomach. This may take many years to develop and is usually preceded by a further cell change within the Barrett’s lining to abnormal appearing cells (dysplasia). These are best diagnosed by examining small tissue samples under the microscope.

The abnormal cells are thought to progress through low grade dysplasia to high grade dysplasia before becoming cancerous.

It can, however, take up to 10 years for dysplasia to develop into cancer although, in some people, cancer may have already started developing within the area of high-grade dysplasia at the time it is diagnosed.

This gradual progression explains why an increasing number of hospitals perform endoscopies at regular intervals. The aim is to detect any dysplasia before it progresses to cancer.