Barrett's Oesophagus
Barrett's oesophagus is a condition in which the flat pink lining of the swallowing tube that connects the mouth to the stomach (oesophagus) becomes damaged by acid reflux, which causes the lining to thicken and become red.
Between the oesophagus and the stomach is a critically important valve, the lower oesophageal sphincter (LES). Over time, the LES may begin to fail, leading to acid and chemical damage of the oesophagus, a condition called gastro-oesophageal reflux disease (GORD). GORD is often accompanied by symptoms such as heartburn or regurgitation. In some people, this GORD may trigger a change in the cells lining the lower oesophagus, causing Barrett's oesophagus.
Barrett's oesophagus is associated with an increased risk of developing oesophageal cancer. Although the risk of developing oesophageal cancer is small, it's important to have regular check-ups with careful imaging and extensive biopsies of the oesophagus to check for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent oesophageal cancer.
Symptoms
The development of Barrett's oesophagus is most often attributed to long-standing GORD, which may include these signs and symptoms:
• Frequent heartburn and regurgitation of stomach contents
• Difficulty swallowing food
• Less commonly, chest pain
Curiously, approximately half of the people diagnosed with Barrett's oesophagus report little if any symptoms of acid reflux. So, you should discuss your digestive health with your doctor regarding the possibility of Barrett's oesophagus.
When to see a doctor
If you've had trouble with heartburn, regurgitation and acid reflux for more than five years, then you should ask your doctor about your risk of Barrett's oesophagus.
Seek immediate help if you:
• Have chest pain, which may be a symptom of a heart attack
• Have difficulty swallowing
• Are vomiting red blood or blood that looks like coffee grounds
• Are passing black, tarry or bloody stools
• Are unintentionally losing weight
Causes
The exact cause of Barrett's oesophagus isn't known. While many people with Barrett's oesophagus have long-standing GORD, many have no reflux symptoms, a condition often called "silent reflux."
Whether this acid reflux is accompanied by GORD symptoms or not, stomach acid and chemicals wash back into the oesophagus, damaging oesophagus tissue and triggering changes to the lining of the swallowing tube, causing Barrett's oesophagus.
Risk factors
Factors that increase your risk of Barrett's oesophagus include:
• Family history. Your odds of having Barrett's oesophagus increase if you have a family history of Barrett's oesophagus or oesophageal cancer.
• Being male. Men are far more likely to develop Barrett's oesophagus.
• Being white. White people have a greater risk of the disease than do people of other races.
• Age. Barrett's oesophagus can occur at any age but is more common in adults over 50.
• Chronic heartburn and acid reflux. Having
GORD that doesn't get better when taking medications known as proton pump inhibitors or having GORD that requires regular medication can increase the risk of Barrett's oesophagus.
• Current or past smoking.
• Being overweight. Body fat around your abdomen further increases your risk.
Complications
Oesophageal cancer
People with Barrett's oesophagus have an increased risk of oesophageal cancer. The risk is small, even in people who have precancerous changes in their oesophagus cells. Fortunately, most people with Barrett's oesophagus will never develop oesophageal cancer.
Diagnosis & Treatment
Diagnosis
Endoscopy is generally used to determine if you have Barrett's oesophagus.
A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing oesophagus tissue. Normal oesophagus tissue appears pale and glossy. In Barrett's oesophagus, the tissue appears red and velvety.
Your doctor will remove tissue (biopsy) from your oesophagus. The biopsied tissue can be examined to determine the degree of change.
Determining the degree of tissue change
A doctor who specializes in examining tissue in a laboratory (pathologist) determines the degree of dysplasia in your oesophagus cells. Because it can be difficult to diagnose dysplasia in the oesophagus, it's best to have two pathologists — with at least one who specializes in gastroenterology pathology — agree on your diagnosis. Your tissue may be classified as:
• No dysplasia, if Barrett's oesophagus is present but no precancerous changes are found in the cells.
• Low-grade dysplasia, if cells show small signs of precancerous changes.
• High-grade dysplasia, if cells show many changes. High-grade dysplasia is thought to be the final step before cells change into oesophageal cancer.
Screening for Barrett's oesophagus
Barrett's oesophagus diagnosis
Screening may be recommended for men who have had GORD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:
• Having a family history of Barrett's oesophagus or oesophageal cancer
• Being male
• Being white
• Being over 50
• Being a current or past smoker
• Having a lot of abdominal fat
While women are significantly less likely to have Barrett's oesophagus, women should be screened if they have uncontrolled reflux or have other risk factors for Barrett's oesophagus.
Treatment
Treatment for Barrett's oesophagus depends on the extent of abnormal cell growth in your oesophagus and your overall health.
No dysplasia
Your doctor will likely recommend:
• Periodic endoscopy to monitor the cells in your oesophagus. If your biopsies show no dysplasia, you'll probably have a follow-up endoscopy in one year and then every three to five years if no changes occur.
• Treatment for GORD. Medication and lifestyle changes can ease your signs and symptoms. Surgery or endoscopy procedures to correct a hiatal hernia or to tighten the lower oesophageal sphincter that controls the flow of stomach acid may be an option.
Low-grade dysplasia
Low-grade dysplasia is considered the early stage of precancerous changes. If low-grade dysplasia is found, it should be verified by an experienced pathologist. For low-grade dysplasia, your doctor may recommend another endoscopy in six months, with additional follow-up every six to 12 months.
But, given the risk of oesophageal cancer, treatment may be recommended if the diagnosis is confirmed. Preferred treatments include:
• Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer.
• Radiofrequency ablation, which uses heat to remove abnormal oesophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.
• Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the oesophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells.
If significant inflammation of the oesophagus is present at initial endoscopy, another endoscopy is performed after you've received three to four months of treatment to reduce stomach acid.
High-grade dysplasia
GORD surgery
High-grade dysplasia is generally thought to be a precursor to oesophageal cancer. For this reason, your doctor may recommend endoscopic resection, radiofrequency ablation or cryotherapy. Another option may be surgery, which involves removing the damaged part of your oesophagus and attaching the remaining portion to your stomach.
Recurrence of Barrett's oesophagus is possible after treatment. Ask your doctor how often you need to come back for follow-up testing. If you have treatment other than surgery to remove abnormal oesophageal tissue, your doctor is likely to recommend lifelong medication to reduce acid and help your oesophagus heal.
An Endoscopy is generally used to determine if you have Barrett's oesophagus. but what does that entail?
This is a procedure where a lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing oesophagus tissue.
Normal oesophagus tissue appears pale and glossy. In Barrett's oesophagus, the tissue appears red and velvety.
Your doctor will then remove some tissue (biopsy) from your oesophagus. The biopsied tissue will then be examined to determine the degree of change.
A doctor who specializes in examining tissue in a laboratory, known as a pathologist, will determine the degree of dysplasia in your oesophagus cells.
Your tissue may be classified as followed:
Treatment
Treatment for Barrett's oesophagus depends on the extent of abnormal cell growth in your oesophagus.
For no dysplasia, your doctor will likely recommend the following:
Care at Chartwell Hospital
At Chartwell Digestive Health we have a team of experienced gastroenterology specialists, dedicated to providing the best possible care for all of our patients.
We diagnose and treat common abdominal symptoms such as rectal bleeding, change in bowel habit and abdominal pain which can be distressing for patients. In most cases, the symptoms are due to underlying health problems. However, for more serious cases, early detection, diagnosis, and treatment is key to recovery.
Our specialist team use comprehensive examinations and testing to diagnose various conditions. In addition to testing blood and stool samples, our Consultant Gastroenterologists may use other diagnostic tools including colonoscopy, gastroscopy, flexible sigmoidoscopy, MRI, X-rays, and CT scans.
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