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Barrett's oesophagus

Published by Bupa's health information team, May 2009.

This factsheet is for people who have Barrett's oesophagus, or who would like information about it.

In Barrett's oesophagus, long-term acid reflux (leaking of acid from the stomach) causes changes in the cells lining the lower part of the oesophagus - the pipe that goes from the mouth to the stomach. It is associated with symptoms such as heartburn.

About Barrett's oesophagus
Symptoms of Barrett's oesophagus
Causes of Barrett's oesophagus
Diagnosis of Barrett's oesophagus
Treatment of Barrett's oesophagus
Living with Barrett's oesophagus
Questions and answers
Related topics
Further information
Sources

About Barrett's oesophagus

In Barrett's oesophagus, some of the cells that line the lower part of your oesophagus start to grow abnormally, becoming more like the cells that line your stomach.

Illustration showing the digestive system
The digestive system

Most people with Barrett's oesophagus don't have any serious problems and may never even be aware that they have the condition. However, occasionally, some of the cells can become increasingly abnormal and develop into cancer. Less than one in 100 people with Barrett's oesophagus develop oesophageal cancer every year, and it usually takes many years to develop.

If the abnormal cells in your oesophagus do become cancerous, they will first go through a series of pre-cancerous changes, which are called dysplasia. The vast majority of people who have Barrett's oesophagus don't develop these abnormalities. Dysplasia can be classified as low-grade or high-grade, depending on how abnormal the cells are. High-grade is the most abnormal, and means that the cells are at the most risk of becoming cancerous.

Although most people with Barrett's oesophagus will not get oesophageal cancer, your doctor may monitor your condition to make sure any changes in your cells are detected and treated early.

Symptoms of Barrett's oesophagus

Common symptoms associated with Barrett's oesophagus include:

heartburn
indigestion
having a sour taste in the back of your throat

Less common symptoms, which may be a sign of more serious problems, can include:

feeling sick and vomiting
difficulty or pain when swallowing food
blood in the vomit or faeces

These symptoms may be caused by problems other than Barrett's oesophagus. You should visit your GP for advice if you regularly get any of the symptoms listed.

Some people with Barrett's oesophagus don't get any symptoms at all.

Causes of Barrett's oesophagus

Barrett's oesophagus is caused by acid reflux. This is when acid from your stomach leaks back up into your oesophagus.

Usually, your stomach acid is kept in your stomach by a muscular valve. But in Barrett's oesophagus, this valve becomes weakened or moved out of place. Acid doesn't harm your stomach, as it is lined by tissue that is resistant to acid. But the lining of the oesophagus is different, and can become inflamed and irritated by the acid.

You are more likely to get acid reflux if you:

are overweight
smoke
drink alcohol to excess
eat lots of spicy, acidic or fatty foods
have a hiatus hernia (this is when part of your stomach slides up into your chest)

Only about one in 10 people who have acid reflux go on to develop Barrett's oesophagus. You are more likely to develop it if you have had severe symptoms for many years, if you are a man, or if you are over 50.

Diagnosis of Barrett's oesophagus

You may only find out that you have the condition when having tests for something else. Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may refer you to a hospital for a test called a gastroscopy (also called an endoscopy). The test may be carried out by a specialist nurse or a doctor. It allows the doctor or nurse to look inside your oesophagus and stomach, using a narrow, flexible, tube-like telescope called an endoscope. See Related topics for more information.

Sometimes, the doctor or nurse may also take a small sample of tissue (a biopsy) from the lining of the oesophagus. This will be sent to a laboratory to see if the cells are normal.

You may also be referred to a gastroenterologist - a doctor specialising in diseases affecting the digestive system.

Treatment of Barrett's oesophagus

Treatment is aimed at preventing further acid reflux and if necessary, removing the abnormal areas of tissue from the oesophagus.

Self-help

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

losing weight, if you are overweight
stopping smoking
drinking less alcohol
avoiding foods that aggravate your symptoms
eating smaller meals at regular intervals, rather than eating a large amount in one go

Lifestyle changes may help your reflux symptoms, but there is no evidence that they can reduce the abnormal areas of tissue in your oesophagus.

Medicines

Your doctor may prescribe medicines to reduce the amount of stomach acid you produce, reducing the acid reflux you get. These are usually medicines called proton pump inhibitors. You will need to keep taking these medicines for the rest of your life to control your symptoms. Proton pump inhibitors are very safe over the long term.

Sometimes your doctor may also prescribe another type of medicine called a histamine receptor blocker.

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 reasons the surgeon may suggest you have surgery for Barrett's oesophagus.

One is to strengthen the valve at the bottom of your oesophagus, preventing further reflux. Your doctor may suggest this if treatment with medicines hasn't been enough to help your symptoms.
The other is to remove the abnormal cells in your oesophagus. Your doctor may advise this if tests show the cells are continuing to change, and there is thought to be a risk of them progressing to cancer.

Your doctor or surgeon will advise you if either of these types of surgery would be helpful or appropriate for you.

Strengthening the valve in your oesophagus usually involves making a small cut in your chest, in order to reach the oesophagus. The surgeon will tighten the valve either by placing stitches in the valve, by injecting it with a substance that will help it to tighten, or by passing an electrical current through the valve. Sometimes, the top part of your stomach may be sewn around the bottom end of your oesophagus, in order to strengthen it. This is called fundoplication.

Surgery to remove the abnormal cells in your oesophagus involves opening up your stomach and chest to take out the affected section of your oesophagus. This is called an oesophagectomy. Your stomach will then be joined to the remaining part of your oesophagus. This is a major operation and it can take several months to fully recover.

Non-surgical treatments

There are a number of new therapies that are currently being investigated for the treatment of Barrett's oesophagus. These include laser therapy, argon plasma coagulation or cryotherapy. More research needs to be done on these treatments to find out how useful they are for Barrett's oesophagus, and they may not be available in all hospitals.

The main treatments under investigation include the following.

Photodynamic therapy. This treatment uses a laser to deliver light energy to destroy the abnormal cells in your oesophagus. You will be given a special drug, called a photosensitising agent, which makes the abnormal cells sensitive to the light. It is mainly offered to people who have high-grade dysplasia.
Radiofrequency ablation. This uses heat to destroy the abnormal cells. A probe is used to apply an electrical current to the abnormal cells in your oesophagus, which heats them up until they're destroyed. This treatment is very new, and so you will only be offered it as part of a clinical trial.
Endoscopic mucosal resection. This is a procedure in which the abnormal part of the lining is removed from the oesophagus while you have a gastroscopy. It isn't as major an operation as an a oesophagectomy (surgery to remove part of your oesophagus). However it's still a specialised technique and is not currently widely available.

Your doctor or surgeon will tell you if any of these treatments are available in your hospital, and if they are suitable for you. You may need to be referred to a hospital which specialises in these treatments.

Living with Barrett's oesophagus

Once you have been diagnosed with Barrett's oesophagus, your doctor may want to continue to monitor your condition. This involves having a gastroscopy and samples of the cells in your oesophagus taken at regular intervals. This is so that your doctor can detect any abnormal changes in the cells in your oesophagus as soon as possible. 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 and the policy of your hospital.

It isn't always necessary to monitor Barrett's oesophagus in this way. You should discuss your situation with your doctor.