The oesophagus is the muscular tube that carries food from the mouth to the stomach, it is also known as the food pipe or gullet.
When people talk or write about Barrett’s oesophagus, the name is sometimes shortened to just ‘Barrett’s’.
Barrett’s is a ‘potentially precancerous condition’, where some of the normal cells in the lining of your oesophagus have changed to be ‘abnormal’ & more at risk of turning into cancer.
It does not mean you have cancer. But it can be a warning sign.
A small number of people who develop Barrett’s go on to develop oesophageal cancer.
Most people with Barrett’s don’t develop this cancer. But if you have it, your doctors will probably want to give you some medication, keep a closer eye on you and/or send you for some treatment.
There are no specific symptoms for Barrett’s but it is often associated with reflux which is the main risk factor. Reflux also known as gastro-oesophageal reflux disease (GORD). This is where acid or juices from the stomach or small intestine escape & flow back up into the oesophagus, which often gives people heartburn.
It can also:
Reflux or heartburn is often worse first thing in the morning, or when lying down. It can also wake people up at night.
If this happens, you should contact your doctor because it’s a commonly reported symptom for people with Barrett’s.
Unfortunately, people often treat these symptoms without going to the doctor.
They buy over-the-counter antacids (such as Gaviscon or Rennie) from the supermarket or chemist instead. But this can mask a problem and delay the Barrett’s being found, treated, or monitored.
Anyone with heartburn (or any of the other listed symptoms) – regularly for three weeks or more – should always contact their doctor.
The primary characteristic of Barrett’s is the presence of ‘abnormal cells’ in the oesophagus lining, typically originating where the oesophagus connects to the stomach.
These cells form as the lining heals from damage caused by stomach acid or bile.
During the repair process, the body generates cells resembling those from the stomach or intestines, rather than the normal oesophagus lining cells.
Over time, these changed cells can develop into something called dysplasia, which is a precancerous condition.
Although, again, not everyone who has dysplasia will develop cancer. It simply increases the risk.
No one knows exactly why these cell changes happen, but it is closely linked with having gastro-oesophageal reflux disease (GORD) for a long time.
GORD is where the reflux – stomach juices that flush back up into the oesophagus inflame and damage the lining of the oesophagus.
About 1 in 10 people with GORD will develop Barrett’s oesophagus.
The risk of developing Barrett’s increases with how long you’ve had a problem with reflux/GORD, how often you have symptoms and how severe those symptoms are.
To diagnose Barrett’s, doctors need to know what’s happening to the cells in the lining of your oesophagus.
They usually do this in three ways.
Treatment options are normally based on four things:
1. The grade and location of the Barrett’s
2. How big the area affected is
3. Your own health history
4. Your family health history
Common treatment options
If you have Barrett’s, you may be offered a combination of these treatments.
Treatments to deal with the abnormal cells or damage in the oesophagus.
1. Intense Surveillance (active watching)
If you have Barrett’s, you will sometimes be monitored closely by having regular endoscopies. The decision on how often to undertake surveillance is based on a discussion between the patient and the hospital who diagnosed the Barrett’s.
Sometimes, people will be offered procedures that treat or remove the damaged segment of the oesophagus.
2. Endoscopic Mucosal Resection – EMR
This is where a doctor will remove abnormal cells from the inside of the oesophagus in a similar way to the camera test used to look for the cancer. This may need to be done more than once.
3. Endoscopic submucosal dissection – ESD
This is a procedure used to remove early-stage cancer in the lining of the oesophagus (food pipe). It is similar to EMR but it removes the abnormal area in one segment. ESD not only removes in one piece but is a deeper resection down to the submucosal layer so is generally used for early cancers that are a bit deeper (we categorise as T1a and T1b).
4. Radiofrequency Ablation – RFA
This is a treatment, which uses radiofrequency, a type of heat therapy to treat the area of Barrett’s oesophagus. The treatment is given during an endoscopy procedure and patients go home the same day. It’s quite usual for people to have more than one treatment to deal with all abnormal cells.
Treatments to try and stop the acid from reaching the oesophagus (and doing more damage)
1. Medication to reduce the acid level in your stomach.
2. Lifestyle changes
3. Surgery called a Laparoscopic Anti-reflux Surgery (LARS) – Also known as Nissen Fundoplication
The oesophagus (which is pronounced o-sof-a-gus) is the muscular tube that joins the mouth and the stomach and is sometimes called the food pipe or the gullet.
This tube is normally lined by a layer of short, flat cells, called squamous cells.
This lining is similar to skin. It is multi-layered and protects the oesophagus from injury caused by swallowed food and stomach acid.
The oesophagus is not designed to cope with regular exposure to the strong acid or bile in the stomach. It’s when this acid gets misplaced that causes many of the main health issues, including inflammation, damage, cell changes and cancer.
Receiving a new diagnosis is sometimes a daunting experience and you are bound to have questions. Talking to others in similar situations can be helpful. Heartburn Cancer UK has an online support forum for patients with Barrett’s and oesophageal cancer. The link to join the closed group is here.
If you have just received a Barrett’s diagnosis, please read our Just Diagnosed leaflet here.
