Barrett’s Oesophagus

What is Barrett’s Oesophagus?

Barrett’s oesophagus is a condition that causes a replacement (metaplasia) of the cells lining the oesophagus (gullet, or food pipe) due to persistent damage from gastroesophageal reflux disease (GERD).  Patients with Barrett’s oesophagus may have a higher risk of developing oesophageal adenocarcinoma, a type of oesophageal cancer.

About Barrett’s Oesophagus and GERD

GERD is the result of stomach acid frequently flowing upwards into the oesophagus from the stomach, past the gastroesophageal junction (GEJ).

Over time, repetitive exposure of stomach acid can irritate and damage the oesophagus, triggering metaplasia of normally occurring flat (squamous) cells with long (columnar) cells typically found in the intestines. Abnormal growth (dysplasia) of these cells can lead to pre-cancerous lesions. Barrett’s oesophagus develops in around 6–14% of patients with GERD, of which, around 0.5–1% will progress to oesophageal cancer.

Many people with Barrett’s may suffer from silent reflux and not experience GERD symptoms until it has progressed. Therefore, it is important to be aware of the risks, prevention, and symptoms associated with Barrett’s oesophagus.

Risk Factors & Prevention

GERD and its progression to Barrett’s oesophagus is a multifactorial disease implicated with genetic predisposition and environmental factors that are slowly being understood.

Risk factors for Barrett’s oesophagus that can be controlled include:

• Smoking
• Alcohol consumption
• Diet high in salted, smoked, pickled foods
• Lack of physical exercise
• Obesity

Risk factors for Barrett’s oesophagus that cannot be controlled include:

• Gender
• Age
• Ethnicity

Healthy lifestyle habits such as a diet filled with fruits, vegetables, and dietary fibre, along with regular physical exercise can reduce your risk of developing Barrett’s oesophagus.

Symptoms

Barrett’s oesophagus can develop and progress over several years, in some cases, symptoms can remain mild and go unnoticed until the disease has advanced.   

When symptoms do appear, they may include:

• Pain or difficulty swallowing (dysphagia)
• Persistent sore throat
• Chronic cough
• Pressure in the chest
• Acid reflux, indigestion, or heartburn (gastroesophageal reflux disease – GERD)
• Vomiting and frequent choking on food
• Unexplained weight loss
• Black, tarry, or bloody stool

Diagnosis, Management & Treatment

Barrett’s oesophagus is diagnosed with an upper gastrointestinal endoscopy and tissue biopsy, under sedation.

The endoscopy allows the gastroenterologist to visually check changes in the lining of the oesophagus. The tissue samples collected will be analysed and confirmed by at least two pathologists to determine the degree of change in the cells lining the oesophagus. Barrett’s does not affect the entire oesophagus, rather it expands upwards in vertical segments, so biopsies are typically collected from all suspected areas in the oesophagus.

Barrett’s oesophagus is classified as:

• No dysplasia: Barrett’s oesophagus (metaplasia) with no pre-cancerous changes
• Low-grade dysplasia: Cells show signs of pre-cancerous changes
• High-grade dysplasia: Cells show many signs of pre-cancerous changes

For most patients, Barrett’s oesophagus is a lifelong condition. There are however, several treatment options including medications that can reduce GERD symptoms and prevent further damage, to the oesophagus, and endoscopic ablative therapies, endoscopic mucosal resections, or surgery.

Your gastroenterologist will evaluate your overall medical condition and degree of dysplasia to determine the best course of treatment and frequency of endoscopic monitoring.

Prognosis

The majority of people diagnosed with Barrett’s oesophagus will not progress to oesophageal cancer, as the risk of progression to cancer is 0.1 to 0.5% per year. However, these patients will require routine surveillance as they are at a higher risk than the general population.