Barrett's oesophagus is a condition that affects the bottom of the gullet or oesophagus. It's
a change in the lining of oesophagus from the normal pale coluor or skin like lining to a
salmon pink lining and essentially, the cells are replaced by cells that are very typical
of the cells in the stomach or intestines and differ from the cells lining the oesophagus.
The most important aspect of Barrett's oesophagus is that in some people, a minority of those
with Barrett's, there’s an increased risk of oesophageal cancer.
About 40% of people who have Barrett's oesophagus don't have any symptoms. I think this is because
because Barrett's is an active response to acid reflux. Once this is developed, there’s
very little inflammation to cause pain. However, 60% of patients with Barrett's have symptoms
typical of acid reflux. These include heartburn, chest pain, regurgitation of food and
fluid particularly at night when you lie down and recurrent belching.
Occasionally, patients with Barrett's do experience difficulty in swallowing. However, that’s
unusual and should be considered as a symptom of concern and will usually require investigation
such as an endoscopy. The main cause of us oesophagus is reflux of
acid or gastroesophageal acid reflux. In fact, all patients with Barrett's have gastroesophageal
reflux. Most patients with Barrett’s also have a hiatus hernia and a hiatus hernia is
where part of the top of the stomach comes through the diaphragm into the chest and this
means that the anti-reflux mechanism or anti-reflux barrier is slightly impaired allowing more
acid to come up from the stomach into the oesophagus.
It's not due to an excessive acid simply more acid moving from a stomach up into the chest.
Those at risk include those who are overweight, those with obesity, but also those with the
family history of Barrett’s oesophagus. Now, patients with Barrett’s have an increased
risk of oesophageal cancer and not everyone with Barrett’s get oesophageal cancer. In
fact, far less that 5% of those with Barrett’s oesophagus.
There are additional risk factors for oesophageal cancer. That depends on the length of the
Barrett’s or Barrett’s can be short or long, a family history of oesophageal cancer,
smoking, being a man, and again obesity. The vast majority of patients with Barrett’s
oesophagus are simply treated with anti-reflux medication. These include the proton pump
inhibitors or PPI’s and it include drugs such as omeprazole or lansoprazole. Occasionally,
the Barrett’s cells can change and when they do change, they become dysplastic or
develop early cancer. It's therefore important to keep an eye on patients with Barrett’s
with repeat endoscopies and these should be done anywhere between 1, 2, 3, 4 or even 5
years depending on the type of Barrett’s and how high the risk is.
Where there is a high risk of cancer development. It's important to treat those cells and assist
on with the combination of endoscopic therapy either cutting out the abnormal cells with
a procedure called endoscopic mucosal resection or EMR or burning the cells off with the treatment
called radiofrequency ablation or FA with a hollow device.