Dr. Campman In Barrett's oesophagus the cells that line the lower gullet (oesophagus) are abnormal. The main cause is long-standing reflux of acid from the stomach into the oesophagus. People with Barrett's oesophagus have an increased risk of developing cancer of the oesophagus. The risk is small. However, you may be advised to have regular endoscopies to detect precancerous changes to the cells in the oesophagus. If precancerous changes develop then treatment to remove or destroy the precancerous cells may be advised. Understanding the oesophagus
and stomach When we eat, food passes down the oesophagus into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make a thick liquid (mucus) which protects them from damage caused by the acid. The cells on the inside lining of the oesophagus are different and have little protection from acid.
There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down but normally tightens up and stops food and acid leaking back up (refluxing) into the oesophagus. So, the sphincter acts like a valve. What is Barrett's oesophagus? Barrett's oesophagus is a condition which affects the lower oesophagus. It is named after the doctor who first described it.
In Barrett's oesophagus, the cells that line the affected area of oesophagus become changed.
The cells of the inner lining (epithelium) of a normal oesophagus are pinkish-white, flat cells (squamous cells). The cells of the inner lining of the area affected by Barrett's oesophagus are tall, red cells (columnar cells). The columnar cells are similar to the cells that line the stomach. What causes Barrett's oesophagus and how common is it? The cause in most cases is thought to be due to long-term reflux of acid into the oesophagus from the stomach. The acid irritates the lining of the lower oesophagus and causes inflammation (oesophagitis). With persistent reflux, eventually the lining (epithelial) cells change to those described above.
It is thought that about 1 in 20 people who have recurring acid reflux eventually develop Barrett's oesophagus. The risk is mainly in people who have had severe acid reflux for many years. However, some people who have had fairly mild symptoms of reflux for years can develop Barrett's oesophagus.
Barrett's oesophagus seems to be more common in men than in women. It typically affects people between the ages of 50 and 70 years. Other risk factors for Barrett's oesophagus that have been suggested include smoking and being overweight (particularly if you carry excess weight around your middle). You are also more likely to develop Barrett's oesophagus if someone else in your family already has the condition. What are the symptoms of acid reflux and inflammation of the
oesophagitis? Heartburn is the main symptom. It is a burning feeling that rises from the upper abdomen or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart.) Other common symptoms include: Feeling sick (nauseated). An acid taste in the mouth. Bloating. Belching. A burning pain when you swallow hot drinks.
Like heartburn, these symptoms tend to come and go and tend to be worse after a meal. People with Barrett's oesophagus will usually have (or will have had in the past) the symptoms associated with acid reflux and oesophagitis. What causes acid reflux and
who is affected by it? The circular band of muscle at the bottom of the oesophagus is called the sphincter. It normally prevents acid reflux. Problems occur if the sphincter does not work very well. This is common but in most cases it is not known why it does not work so well. However, having a hiatus hernia makes you more prone to reflux. A hiatus hernia occurs when part of your stomach protrudes through the lower chest muscle (diaphragm) into the lower chest
Most people have heartburn at some time, perhaps after a large meal. However, about 1 in 3 adults have some heartburn every few days, and nearly 1 in 10 adults have heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. It is people who have severe and long-standing reflux who are more likely to develop Barrett's oesophagus. How is Barrett's oesophagus
diagnosed? Gastroscopy (endoscopy) - if you have severe or persistent symptoms of acid reflux. For this test, a thin, flexible telescope is passed down the gullet (oesophagus) into the stomach. This allows a doctor to look inside. This test can usually help to diagnose Barrett's oesophagus. The change in colour of the lining of the lower oesophagus from its normal pale white to a red colour strongly suggests that Barrett's oesophagus has developed.
A biopsy – usually taken at the same time as the gastroscopy if abnormalities are seen. These are sent to the laboratory to be looked at under the microscope. The characteristic columnar cells which are described above confirm the diagnosis. The cells are also examined to see if they have any signs of dysplasia. What is the treatment for
Barrett's oesophagus? Treatment of acid reflux You are likely to be advised to take acid-suppressing medication for the rest of your life. It is unclear as to whether treating the acid reflux helps to treat or reverse your Barrett's oesophagus and more studies are ongoing. However, this treatment should help any symptoms that you may have. Monitoring When you have been diagnosed with Barrett's oesophagus, you may be advised to have a gastroscopy and biopsy at regular intervals to monitor the condition. This is called surveillance. The biopsy samples aim to detect whether dysplasia has developed in the cells, in particular if high-grade dysplasia has developed.
The exact time period between each gastroscopy and biopsy sample can vary from person to person. It may be every 2-3 years if there are no dysplasia cells detected. Once dysplasia cells are found, the check may be advised every 3-6 months or so. If high-grade dysplasia develops, you may be offered treatment to remove the affected cells from the oesophagus
Surgery may be considered. This is quite major surgery and if required will be fully explained to you by your Dr. Newer treatments There are now various ways of removing just the abnormal cells from the lining of the oesophagus. These include the following:
Photodynamic therapy (PDT): this is a type of laser treatment.
Epithelial radiofrequency ablation (EFA): this treatment uses a radiofrequency energy coil. The coil then emits heat energy which destroys the abnormal cells. Nearby normal cells then multiply and replace the destroyed abnormal cells.
Argon plasma coagulation: this treatment uses a jet of argon gas, together with an electric current, to burn away dysplastic cells.
Endoscopic mucosal resection (EMR): this is a procedure that is done via instruments passed down the side of a gastroscope.
If you are diagnosed with Barrett's oesophagus, your specialist should be able to give you up-to-date information on which treatment is best for you. Send your medical queries or problems to: firstname.lastname@example.org or see advert below