What is Barrett’s Oesophagus?
Normally, the oesophagus is lined by a layer of short, squat cells, called squamous cells. This lining is similar to skin in that it is multi-layered and protects the oesophagus from injury caused by swallowed food. When gastric and duodenal juices flow back up into the oesophagus (called reflux) repeatedly over an extended period, this repeated exposure to acid and bile can injure the lining of the oesophagus. The injury is called oesophagitis.Barrett’s Oesophagus is a condition affecting the lining of the oesophagus, the muscular tube that carries food, liquids and saliva from the mouth to the stomach.
In some cases, as healing occurs the normal squamous lining is replaced by cells that resemble the stomach or intestine, a process called metaplasia or change in cell shape. It is this abnormal lining that is called Barrett’s Oesophagus.
What causes Barrett’s Oesophagus?
Barrett’s Oesophagus results from chronic exposure of the oesophagus to acid and contents of the stomach and sometimes bile from the intestine. This back-wash or reflux of gastric and intestinal contents is called gastro-oesophageal reflux disease, commonly known as GORD or GERD.
With prolonged acid and bile exposure, normal cells can undergo a genetic change and transform into taller columnar cells resembling the stomach or small intestine. These Barrett’s cells are vulnerable to further changes, called dysplasia, which can lead to cancer.
How do I know if I have got Barrett’s Oesophagus?
People with Barrett’s Oesophagus often have bad acid reflux. If you suffer from persistent heartburn you should not ignore it and you may need treatment for the symptoms and an endoscopy to see whether you have Barrett’s Oesophagus. Some individuals may have very few symptoms despite having reflux – this is what can make the condition dangerous.
Barrett’s is diagnosed by a test called endoscopy. This involves a tiny camera on a thin tube that is passed down your oesophagus so that the doctor can look at the lining. The doctor will also take small samples of the cells, called biopsies, so that they can be looked at under the microscope. This is important as the diagnosis can only be accurately made when cells resembling the stomach or intestine have been demonstrated. You cannot currently assess this without the use of a microscope.
How do I know if it is getting worse?
Once a diagnosis has been made regular follow-up endoscopies are generally recommended. At these check-ups the endoscopist will carefully check the Barrett’s area to see whether there are any ulcers or nodules and biopsies will be taken to assess these changes.
Additionally, random biopsies will be taken along the Barrett’s segment – usually four biopsies every two centimetres. These biopsies are examined for any changes that suggest worsening of the condition. These cellular changes are called dysplasia and this is graded as low or high grade.
Will it lead to cancer?
In a very small number of patients the cell changes may develop into cancer. About five to ten per cent of people with Barrett’s Oesophagus will experience the tissue changes that may develop into cancer. That is why people with Barrett’s Oesophagus are urged to have regular check-ups.
The check-ups looks for cells that begin to show abnormal changes may be developing – a condition called dysplasia – which occurs long before cancer develops. Regular monitoring means treatment can be given when changes start to look serious (e.g. high grade dysplasia) before cancer develops.
How many people have Barrett’s Oesophagus?
Up to one in a hundred people in the UK are thought to have Barrett’s Oesophagus. It is more common in individuals with heartburn symptoms.
Does Barrett’s Oesophagus run in families?
Most people with Barrett’s Oeosphagus do not have a family history, although there may be other members of the family who suffer with reflux symptoms but have not had an endoscopy. In a small proportion of Barrett’s sufferers there are other family members affected. This suggests that there may be a contribution of inherited genes to this disease. The particular genes are not known and there is no genetic test. This is an active area of research.
What is the survival rate?
If caught early Barrett’s Oesophagus is highly treatable. It is when oesophageal cancer develops and the diagnosis is late that the prognosis is poor. In symptomatic patients with a Barrett’s cancer 13 per cent of patients survive for five years. In patients with changes of dysplasia diagnosed before cancer develops the condition is curable.
What are the treatments for Barrett’s Oesophagus?
Treatments aim to relieve the symptoms of acid reflux and heartburn and to prevent it developing into cancer.
There are four approaches:
Things you can do for yourself
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Why is it called Barrett’s Oesophagus?
The condition is named after Norman Rupert Barrett (1903-1979). He was born in Adelaide, South Australia and was educated at Eton and Trinity College, Cambridge. He graduated from St Thomas’ Hospital in 1928, becoming a surgeon at St Thomas’ and Brompton Hospitals in London. In 1950, he was among the first to describe the transformation of the oesophageal lining – the condition that bears his name.