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Barrett's oesophagus

In Barrett's oesophagus, the cells that line the lower part of your oesophagus get damaged by acid and bile travelling upwards from your stomach (reflux). Barrett's oesophagus can happen if the reflux happens over a long period of time.

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.

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Details

  • Symptoms Symptoms of Barrett's oesophagus

    You may not get any symptoms of Barrett's oesophagus. However, symptoms of the condition can include:

    • heartburn
    • indigestion

    These symptoms may be caused by problems other than Barrett's oesophagus. If you have any of these symptoms, see your GP for advice.

  • Diagnosis Diagnosis of Barrett's oesophagus

    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 Treatment of Barrett's oesophagus

    Treatment for Barrett's oesophagus aims to prevent further acid reflux and, if necessary, remove any damaged areas of tissue from your oesophagus.

    Self-help

    Your doctor may advise you to make some lifestyle changes in order to reduce your acid reflux. For example:

    • lose weight, if you're overweight
    • stop smoking
    • drink less alcohol and coffee
    • don't eat foods that aggravate your symptoms (keep a diary so you know which foods aggravate your symptoms)
    • eat smaller meals at regular intervals, rather than a large amount in one go
    • raise the head of your bed if you get reflux symptoms at night (you can do this by putting supports under the legs at the head of your bed, so that while sleeping your head is positioned higher than your feet)
       

    Medicines

    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.

    Non-surgical treatment

    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.

    • Radiofrequency ablation uses heat to destroy the abnormal cells. Your doctor will use a probe to apply an electrical current to the abnormal cells in your oesophagus, which will heat them up until they are destroyed. This technique is the most common way of treating high-grade dysplasia.
    • Endoscopic mucosal resection is a treatment in which your doctor will lift the affected tissue away from the wall of your oesophagus and then cut it out. He or she may use ablation therapy before or after this procedure to help get rid of the damaged cells. This technique may be used to remove very early cancer of the oesophagus.
    • Photodynamic therapy uses a laser to deliver light energy to destroy the abnormal cells in your oesophagus. You will first be given a special medicine, called a photosensitising agent, which makes the abnormal cells sensitive to light.
    • Your doctor or surgeon will tell you if any of these treatments are suitable for you. These treatments may not be available in all hospitals, and you may be referred to a hospital that specialises in them.
       

    Surgery

    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.

    Fundoplication

    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.

    Oesophagectomy

    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. 

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  • Causes 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 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:

    • smoke
    • drink alcohol
    • drink coffee
    • eat fatty foods and big meals
    • are overweight
    • have a hiatus hernia (this is when part of your stomach slides up into your chest)
    • are white
    • are male
    • are over 50

    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.

  • Complications Complications of Barrett's oesophagus

    For some people, the constant exposure to acid over a long period of time causes complications, including:

    • ulcers, which can cause pain when you swallow food, and if severe, blood to appear in your vomit or faeces (which will look black and tar-like)
    • scarring of your oesophagus (stricture), which may narrow your oesophagus and make it difficult to swallow
    • cancer of the oesophagus
  • FAQs FAQs

    Does everyone who has oesophageal cancer get Barrett's oesophagus first?

    Answer

    No, not everyone with oesophageal cancer will have had Barrett's oesophagus first.

    Explanation

    There are two types of oesophageal cancer – adenocarcinoma and squamous cell carcinoma. Adenocarcinoma is usually associated with Barrett's oesophagus, but squamous cell carcinoma isn't.

    Adenocarcinoma is often connected with acid reflux. In most people, this happens over a long period of time. The cells in your oesophagus gradually go through a series of changes, because of the acid that damages the lining of your oesophagus. Barrett's oesophagus is the first stage of these changes and it puts you at increased risk of developing adenocarcinoma. Most people who develop adenocarcinoma have Barrett's oesophagus, but only a small number of people with Barrett’s oesophagus will go on to develop adenocarcinoma.

    Many people who develop adenocarcinoma of the oesophagus were unaware they had Barrett's oesophagus. However, if you have any symptoms that may be caused by Barrett’s oesophagus, such as heartburn or indigestion, or if you have reflux, or pain or difficulty swallowing, seek advice from your GP.

    Will radiofrequency ablation therapy cure my Barrett's oesophagus?

    Answer

    Radiofrequency ablation therapy may cure Barrett's oesophagus. The treatment is usually only given to people with high-grade dysplasia.

    Explanation

    Radiofrequency ablation can completely cure Barrett's oesophagus. After treatment it's likely that you will still need to take acid suppressing medicines but you will have a significantly lower risk of oesophageal cancer. Radiofrequency ablation is usually recommended as an alternative to surgery if you have high-grade dysplasia.

    There are some disadvantages to radiofrequency ablation. You may experience some discomfort behind your breastbone (sternum), but this is unlikely to stop you carrying out your usual daily activities. There is a risk you may develop areas of narrowing (strictures) in your oesophagus. These can be corrected by further endoscopic treatment but can often reoccur. Other potential side-effects of the treatment include bleeding and punctures in your oesophagus.

    Ask your doctor for more information about the potential benefits and risks of your treatment.

    How long does it take for Barrett's oesophagus to develop into cancer?

    Answer

    Most people with Barrett's oesophagus don't go on to develop cancer at all. In those who do, it usually takes many years for the cancer to develop. It's not possible to predict how long it will take for this change to occur in any individual person.

    Explanation

    The progression of Barrett's oesophagus to cancer is usually a very gradual process that happens over a number of years. Cells in the damaged area of the oesophagus go through a number of changes before they become cancerous. These changes are called metaplasia and dysplasia, which can be labelled low-grade or high-grade depending on the severity of the changes. Cells with high-grade dysplasia have changed the most and have the highest risk of developing into cancer. Cells with dysplasia are sometimes referred to as pre-cancerous.

    It can take up to 10 years for dysplasia to develop into cancer, although this is different for everyone. In some people, the dysplasia never progresses to cancer. Certain factors can increase your risk of progressing to oesophageal cancer, including old age, being male, smoking, and having more than 8cm of your oesophagus affected by Barrett's oesophagus.

    If you're diagnosed as having Barrett's oesophagus with dysplasia, your doctor will probably suggest that you have more frequent check-ups so he or she can monitor any changes in your cells. You may be referred to a specialist unit. If you have high-grade dysplasia, your doctor may recommend that you have one of the endoscopic treatments, such as radiofrequency ablation, to remove the damaged cells.

  • Resources Resources

    Further information

    Sources

    • Barrett esophagus. eMedicine. www.emedicine.medscape.com, published 18 March 2013
    • What is Barrett's oesophagus? Cancer Research UK. www.cancerresearchuk.org, published 8 August 2012
    • Guidelines for the diagnosis and management of Barrett’s columnar-lined oesophagus. British Society of Gastroenterology. www.bsg.org.uk, published August 2005
    • Rees JRE, Lao-Sirieix P, Wong A, et al. Treatment for Barrett's oesophagus. Cochrane Database of Systematic Reviews 2010, Issue 1. doi: 10.1002/14651858.CD004060.pub2.
    • Study suggests oesophageal cancer 'less common than previously thought' in people with Barrett's oesophagus. Cancer Research UK. www.cancerresearchuk.org, published 13 October 2011
    • Barrett's oesophagus. Map of Medicine. www.mapofmedicine.com, published 2 October 2012
    • Jankowski J, Black J, Black J, et al. Diagnosis and management of Barrett’s oesophagus. BMJ 2010; 341:c4551. doi: 10.1136/bmj.c4551.
    • FAQ's. Barrett's Oesophagus Campaign. www.barrettscampaign.org.uk, accessed 13 May 2013
    • Barrett's oesophagus – clinical presentation. Map of Medicine. www.mapofmedicine.com, published 2 October 2012
    • Complications. Barrett's Oesophagus Campaign. www.barrettscampaign.org.uk, accessed 13 May 2013
    • Barrett's oesophagus. Macmillan. www.macmillan.org.uk, published 1 January 2013
    • Barrett esophagus treatment and management. eMedicine. www.emedicine.medscape.com, published 18 March 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed April 2013
    • Dyspepsia: managing dyspepsia in adults in primary care. National Institute for Health and Care Excellence. www.nice.org.uk, published August 2004
    • Barrett's oesophagus – specialist management. Map of Medicine. www.mapofmedicine.com, published 2 October 2012
    • Types of oesophageal cancer. Cancer Research UK. www.cancerresearchuk.org, published 9 July 2012
    • Risks and causes of oesophageal cancer. Cancer Research UK. www.cancerresearchuk.org, published 30 August 2012
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    Reviewed by Rachael Mayfield-Blake, Bupa Heath Information Team, July 2013.

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