In Barrett's oesophagus, acid and bile that refluxes from your stomach causes the skin-like cells in the lower part of your oesophagus to change. They become more like the cells that line your stomach and small intestine.
Barrett's oesophagus is becoming more common in the UK and currently affects around two in every 100 people.
Most people with Barrett's oesophagus don't have any serious problems. However, for a few people, the changes in the cells that line the oesophagus may develop into cancer. Fewer than one in 20 men, and one in 35 women with Barrett's oesophagus develop oesophageal cancer in their lifetime.
It usually takes many years for cancer to develop. During this time the cells go through a series of pre-cancerous changes called metaplasia and dysplasia. A group of cells with dysplasia can be labelled low-grade or high-grade, depending on the how much the cells have changed. Cells that have high-grade dysplasia have changed the most, and have the highest risk of turning cancerous.
Most people with Barrett's oesophagus don't get high-grade dysplasia – fewer than one in 10 people develop these cells in their lifetime. Not everyone who gets high-grade dysplasia will develop oesophageal cancer. However if you do have these cells, your doctor may monitor you so any changes in your cells are detected and treated early.
You may not get any symptoms of Barrett's oesophagus. However, symptoms of the condition can include:
These symptoms may be caused by problems other than Barrett's oesophagus. If you have any of these symptoms, see your GP for advice.
For some people, the constant exposure to acid over a long period of time causes complications, including:
Barrett's oesophagus is caused by long-term reflux of acid and bile. This is when stomach acid and digestive juices travel upwards from your stomach into the lower part of your oesophagus.
Usually, stomach acid is kept in your stomach by a muscular valve that stops it from reaching your oesophagus. However, if you have Barrett's oesophagus, your valve may have become weak or moved out of place, which allows acid to leak upwards. Your stomach is protected from digestive juices by a lining of acid-resistant cells. But the lining of your oesophagus is different, and it can become inflamed and irritated as it tries to protect itself from the acid.
You're more likely to get acid reflux if you:
Only about one in 10 people who have acid reflux go on to develop Barrett's oesophagus. You're more likely to develop Barrett's oesophagus if you have had severe reflux symptoms for many years.
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
If your GP thinks there may be an underlying cause for your symptoms, he or she may offer you a test called a gastroscopy. This may also be called an endoscopy. You may also be offered this test if your symptoms have persisted for a long time. The test allows your doctor or a specialist nurse to look inside your oesophagus and stomach using a narrow, flexible, tube-like telescopic camera. It can help to identify whether your symptoms are caused by Barrett’s oesophagus or another condition.
Sometimes your doctor or nurse may also take a small sample of tissue (a biopsy) from the lining of your oesophagus during the test. This will be sent to a laboratory to be examined to check if the cells are abnormal.
Barrett's oesophagus is sometimes diagnosed if you have a gastroscopy to investigate other problems, such as abdominal (tummy) pain or sickness.
If you're diagnosed with Barrett's oesophagus, your doctor may want to continue to monitor your condition. He or she will ask you to have a gastroscopy with biopsies at regular intervals. This will help your doctor to detect any abnormal changes that may develop in the cells in your oesophagus. You may need to have these check-ups at intervals from anywhere between a few months to three years, depending on how severe your condition is.
It may not always be necessary to monitor Barrett's oesophagus in this way. Ask your doctor for more information.
Treatment for Barrett's oesophagus aims to prevent further acid reflux and, if necessary, remove any damaged areas of tissue from your oesophagus.
Your doctor may advise you to make some lifestyle changes in order to reduce your acid reflux. For example:
Your doctor may prescribe medicines to reduce the amount of stomach acid you produce, which should reduce acid reflux. These are usually medicines called proton pump inhibitors. Examples include omeprazole, rabeprazole or lansoprazole. You may need to take these medicines for the rest of your life to control your symptoms.
Occasionally, your doctor may prescribe another type of medicine called an H2 receptor blocker to reduce the amount of stomach acid you produce. Other drugs, such as domperidone, work by helping your stomach to empty more effectively.
If medicines don't work for you, your GP may refer you to a gastroenterologist to discuss other treatment options. A gastroenterologist is a doctor who specialises in identifying and treating conditions that affect the digestive system.
You may need further treatment if tests show that your cells are continuing to change and there is a risk that they will become cancerous.
Specialist centres offer treatments to remove the layer of damaged cells using an endoscope. Healthy cells usually grow again in the affected area after endoscopic treatments.
Endoscopic treatments include the following.
If your gastroenterologist thinks that you may benefit from surgery, he or she will refer you to a surgeon to discuss your options. There are two types of surgery for Barrett's oesophagus.
This is an operation to strengthen the valve at the bottom of your oesophagus, preventing further acid reflux. In the operation, your surgeon will wrap the top part of your stomach around the bottom end of your oesophagus. Your doctor may recommend this surgery if you have troublesome reflux symptoms and don’t want to take medicines for the rest of your life. It may also be an option if you have side-effects from acid-reducing medicines.
This is an operation to remove the affected area of your oesophagus. Your doctor may advise you to have this surgery if you have developed an early cancer as a complication of Barrett’s oesophagus. In this operation, your surgeon will remove the affected section of your oesophagus and then join your stomach to the remaining part.
Your gastroenterologist or surgeon will advise you if either of these types of surgery would be helpful or appropriate for you.
As with every procedure, there are some risks associated with the surgical and non-surgical treatments of Barrett’s oesophagus. Ask your doctor or surgeon to explain how these risks apply to you.
Reviewed by Rachael Mayfield-Blake, Bupa Heath Information Team, July 2013.
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