About Barrett's oesophagus

Barrett’s oesophagus, often known as just Barrett’s, is a condition that affects the lining of the oesophagus, the muscular tube that carries food, liquids and saliva from the mouth to the stomach. Barrett’s is sometimes referred to as a pre-cancerous condition, meaning that people who have Barrett’s are more likely to develop cancer of the oesophagus than people who do not.  However, this does not happen to the majority of Barrett’s patients.

Normally, the oesophagus is lined by a layer of short, flat 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 and stomach acid. Reflux occurs when juices from the stomach and small bowel flow back up into the oesophagus repeatedly, over an extended period of time. This exposure to acid and bile can injure the lining of the oesophagus and may cause inflammation called oesophagitis. In some cases, as healing occurs, the normal squamous lining is replaced by cells that resemble those in the stomach or intestine, a process called metaplasia or change in cell shape. It is this abnormal lining that is called Barrett’s oesophagus.

One in 10 individuals in the UK with a history of heartburn is estimated to have Barrett’s oesophagus.

In a very few individuals with Barrett’s the cell changes may develop into cancer. Cells that begin to show abnormal changes may gradually be developing a condition called dysplasia which occurs before cancer develops. This is why many people with Barrett’s oesophagus have regular check-ups.

Barrett's oesophagus was first identified in the early 1950s by a surgeon called Norman Barrett. When examined with an endoscope, Barrett's oesophagus appears to be a dark red colour compared with a normal oesophagus, which is due to a richer blood supply. In some people it can extend along the oesophagus from 1 centimetre to 15 centimetres. 

How is Barrett’s Diagnosed?

Barrett’s oesophagus is diagnosed by endoscopy. This involves a tiny camera on a thin tube being passed down your oesophagus so that the doctor can look at the lining. The doctor will also take small samples of the cells, called a biopsy, so that they can be looked at under the microscope.

Author: Dr Sarmed Sami, Consultant Gastroenterologist at University College London Hospitals NHS Trust

He also works as a private Gastroenterologist based in central London at Digestive Health UK

Treatment 

Barrett's oesophagus is normally treated with acid suppression medicine such as proton pump inhibitors (PPIs) to control reflux symptoms. If there are more advanced changes to the cells then treatment is usually recommended to remove the abnormal lining. Recent evidence suggests that combining PPIs with aspirin reduces the chances of Barrett’s progressing to dysplasia or cancer, but this combination should only be taken with the advice of your doctor.

Author: Dr Sarmed Sami, Consultant Gastroenterologist at University College London Hospitals NHS Trust (UCLH).

He also works as a private Gastroenterologist based in central London at Digestive Health UK.

Monitoring

If you have been diagnosed with Barrett’s you may be offered regular check-ups with an endoscopy and biopsy. How often you have these check-ups will depend on your particular case. Most people only need an endoscopy every 2 to 5 years. Occasionally doctors will ask to see you more frequently.

Check-ups allow the doctors to monitor any changes in the cells of your oesophagus and alter your treatment if necessary. This may involve changing the dose of your acid-suppression medication or removing the abnormal areas in the oesophagus. If dysplasia is found early, it can usually be cured before cancer develops.

The diagnosis of Barrett's oesophagus can affect people in different ways.  Some people find a fear of developing cancer extremely difficult to manage and some find physical symptoms or any necessary treatment affects them more.  Feeling upset, scared, frustrated or hopeless are all normal reactions but should be discussed with your GP if they affect your quality of life so that you can receive appropriate support.  Some areas will have specialist nurses or support groups like the ones that we facilitate which enable individuals to meet people with similar experiences or feelings to their own.  It's really important not to suffer alone, always speak to your GP if you have concerns and they will be able to point you in the direction of services in your area that may help.

Podcast

This link to a podcast by RefluxUK has some fascinating discussion about Barrett's oesophagus and features HCUK trustee, Professor Rebecca Fitzgerald as well as Dr Jason Dunn.  Both are leading experts in this field.  The podcast is immensely helpful for those who have been newly diagnosed and contains plenty of interesting information even for those with more understanding.