Barrett's oesophagus

Barrett's oesophagus is when the lining of your lower oesophagus (food pipe) is damaged. It’s caused by acid and bile coming back up from your stomach. Over time, the cells of the lining can become abnormal and there’s a small risk of cancer developing. But most people with Barrett’s oesophagus do not get cancer.

What is Barrett's oesophagus?

Barrett’s oesophagus is named after the surgeon who first described it. It affects up to two in every 100 people, and is more common in men. You can get it at any age, but most people diagnosed are over 50.

Your oesophagus (food pipe) is the tube that joins your mouth to your stomach. When acid and bile come back up your oesophagus from your stomach, this is known as gastro-oesophageal reflux disease (GORD) or acid reflux. Over time, the acid and bile from your stomach can cause the cells in the lower part of your oesophagus to change. Around one in 10 people who have acid reflux for a long time develop Barrett's oesophagus.

Sometimes, these changed cells can become pre-cancerous and eventually cancerous. Doctors call precancerous cells dysplasia (diss-play-zee-ah). Cells that are only slightly abnormal are known as low-grade dysplasia; cells that are more abnormal are known as high-grade dysplasia. The level of dysplasia of your cells determines if you need treatment and what treatment you have.

So, if you have Barrett’s oesophagus, your doctor may ask you to have regular checks for very early signs of cancer.

Symptoms of Barrett's Oesophagus

You may not have any symptoms from Barrett’s oesophagus. But you may have symptoms of gastro-oesophageal reflux disease (GORD), which causes Barrett’s oesophagus. Symptoms of GORD include:

• heartburn
• acid coming up into the back of your mouth
• food coming back up (regurgitation)

Other symptoms can include a sore throat and hoarse voice, caused by the acid reflux, but these are less common. Acid reflux may also cause coughing or wheezing.

Your pharmacist can suggest treatments to help with heartburn or indigestion. But if your symptoms continue, see your doctor for advice.

It’s very important to have your symptoms checked if you have GORD. You may have Barrett’s oesophagus that hasn’t been diagnosed. If you do, your doctor can give you treatment and check-ups aimed at preventing cancer or picking it up at an early stage.

Diagnosis of Barrett's Oesophagus

Your Doctor will ask about your symptoms and may examine you. They may also ask about your medical history.

Your Doctor  may arrange for you to have a test at the hospital called a . In this procedure, a gastroscope is put into your mouth or nose and down into your stomach. A gastroscope is a narrow, flexible tube with a camera on the end so your doctor can see inside your oesophagus and stomach. Your doctor or nurse will usually take small samples of tissue (biopsies) from the lining of your oesophagus. They send these to a laboratory to check for any abnormal cells.

Barrett's oesophagus is sometimes picked up if you have a gastroscopy to investigate another problem, such as abdominal (tummy) pain.

If you have Barrett's oesophagus, your doctor may want to monitor your condition. If so, they’ll arrange for you to have regular gastroscopies with biopsies. These will help to pick up any abnormal changes (dysplasia) that could develop. Your doctor may recommend you have a gastroscopy every six months to five years. This depends on how abnormal your cells are and how much of your oesophagus is affected.

You don’t always need to have Barrett's oesophagus monitored in this way. Your doctor will talk to you about the pros and cons of regular monitoring, and what might be best for you.

Self-help for Barrett's Oesophagus

Your doctor may ask you to make some changes to your lifestyle to help reduce acid reflux. This won’t get rid of the Barrett’s oesophagus, but it may help to control  symptoms. For example, they might suggest you:

• lose weight if you’re overweight
• stop smoking
• avoid food and drinks that make symptoms worse
• eat smaller meals at regular intervals, rather than a large portion in one go
• use an extra pillow or two or raise the head of the bed if you get symptoms at night
• sit upright when you eat and don’t lie down immediately after eating

Barrett’s oesophagus and diet

It may help to keep a , to find out which foods make your symptoms worse. Everyone’s different, but some people find that fatty, spicy or acidic foods, alcohol and caffeine can cause indigestion and reflux. Depending on the findings from your diary, you may find it helpful to:

• grill foods instead of frying
• avoid fatty and processed meats and cheese
• cut down on coffee, chocolate and soft drinks containing caffeine, including energy drinks
• cut down or avoid alcohol and fizzy drinks
• avoid acidic foods, such as tomatoes, citrus fruits and juices
• avoid spicy foods (although if this is your main diet, they may help)
• avoid acidic sauces and condiments, such as ketchup, mustard and vinegar

Your eating patterns can also affect your symptoms. So you may find it helpful to eat regular meals, particularly making sure you have breakfast, and avoid snacking late in the evening.

Treatment for Barrett's Oesophagus

Treatments for Barrett's oesophagus aim to prevent further gastro-oesophageal reflux. And, if necessary, remove damaged areas of tissue from your oesophagus.

Medicines

Your doctor may prescribe medicines to reduce the amount of stomach acid you produce. This should help to reduce gastro-oesophageal reflux. You may have medicines called proton pump inhibitors You may need to take these medicines long-term to control your symptoms.

Non-surgical treatment

If tests show that you have pre-cancerous cells, you may need monitoring with further gastroscopies or treatment. A team of doctors will look at your results and recommend the best options for treatment in your individual circumstances. Your own wishes will also be taken into account.

They may suggest treatment to remove the layer of damaged cells using a gastroscope. This is called endoscopic treatment. It allows healthy cells to regrow over the area.

Endoscopic treatments include the following.

• Radiofrequency ablation uses heat made by radio waves to destroy abnormal cells. This is the most common way to treat Barrett’s oesophagus. Your doctor uses a probe to destroy abnormal cells in your oesophagus.
• Endoscopic mucosal resection is a treatment to remove outgrowths of affected tissue from the wall of your oesophagus. This is often used to remove very early cancer of the oesophagus. You may have radiofrequency ablation afterwards. This is to help get rid of any remaining damaged cells.

Your doctor or surgeon will tell you if any of these treatments are suitable for you. They might not be available in all hospitals, so you may need to go to a hospital that specialises in them.

Surgery

There are two types of surgery for Barrett's oesophagus.

Fundoplication

This operation strengthens the valve at the bottom of your oesophagus. The aim is to prevent further gastro-oesophageal reflux. Fundoplication surgery can help if your symptoms are really bothering you but you don’t want to take medicines for the long term. It may also be an option if you have side-effects from acid-reducing medicines.

Oesophagectomy

Your doctor may suggest this operation if you’ve developed an early cancer. Your surgeon will remove the affected section of your oesophagus. They then join your stomach to the remaining part.

Causes of Barrett's oesophagus

Barrett's oesophagus is caused by long-term reflux of acid and bile. This is when stomach acid and digestive juices come up from your stomach into your oesophagus.

Usually, stomach contents are kept in your stomach by a muscular valve. If you have Barrett's oesophagus, this valve may have become weak or moved out of place. Acid and bile from your stomach can then leak upwards. The cells lining your oesophagus become inflamed and damaged. They eventually get replaced by new cells which are more like the cells that line your stomach. This is your body’s way of protecting the lining of your oesophagus from further damage.

You're more likely to get Barrett’s oesophagus if you have long-term reflux and you:

• are male
• are white
• are over 50
• have someone else in your close family with the condition
• have a hiatus hernia
• smoke
• are overweight

Only about one in every 10 people with chronic reflux go on to develop Barrett's oesophagus. You're more likely to develop it if you’ve had severe reflux symptoms for many years.

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