Barrett's Oesophagus

Damage to the lower part of your oesophagus by reflux can lead to a condition called Barrett's oesophagus.

Barrett's oesophagus was first identified in the early 1950s by a surgeon called Norman Barrett. When examined with an endoscope, Barrett's oesophagus appears to be a dark red colour compared with a normal oesophagus, which is due to a richer blood supply. In some people it can extend up the oesophagus from 1 centrimetre to 15 centimetres. Biopsies are taken to confirm the diagnosis and work out which cell types are present. When these biopsies are examined under the microscope the cells lining the lower end of the gullet, which are normally layered like the skin for protection, have changed to look like those of the stomach or intestine which are more used to handling acid and bile. We don't know how or why this happens.

Barrett's oesophagus appears to be more common in white men and people who are overweight. Although most patients will have experienced reflux symptoms, reflux can go unnoticed. Smoking may be linked to Barrett's oesophagus but is not a strong risk factor, and it is not clear whether heavy drinking plays a role. Barrett's also occurs in people who do not appear to have these risk factors.

Barrett's oesophagus is often undiagnosed and normally doesn't cause any problems. However, like oesophagitis, it can lead to complications such as ulcers in the gullet, bleeding and sometimes difficulty swallowing due to a narrowing of the gullet. The rare, but more serious complication, is cancer.

If you have Barrett's oesophagus diagnosed, it is recommended that you have regular check-ups to make sure that if, in the unlikely event cancer does develop, it can be treated while it is at a curable stage. This regular monitoring, done by endoscopy, is called 'surveillance'. During this the Barrett's is checked and biopsies are taken. The biopsies are examined for changes to the cells called dysplasia. The changes are graded according to how serious they are, using the terms 'no dysplasia', 'low-grade dysplasia' and 'high-grade dysplasia'. How often the check-ups are carried out depend on how serious the changes are.

Barrett's oesophagus is normally treated with acid-suppressant medicine to control reflux symptoms. If high-grade dysplasia is found, treatment is usually recommended to remove the abnormal lining. This may involve taking a larger biopsy (called endoscopic mucosal resection) or removing the entire surface of the Barrett's oesophagus with endoscopy techniques such as argon plasma coagulation, photodynamic therapy or radiofrequency ablation. Or, surgery may be recommended to remove the lower oesophagus affected by Barrett's (an oesophagectomy). These are big decisions and a team of doctors will discuss them with you.

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