Patient information - Barrett's Oesophagus

Endoscopic photograph of Barretts Oesophagus

Cause of Barrett's

The oesophagus (gullet or food tube) is lined with cells akin to those from the skin (squamous cells). In Barrett's oesophagus the cells at the lower end of the oesophagus change their lining into cells akin to those from the stomach (columnar cells).

This is secondary to longstanding reflux of gastric juices from the stomach into the oesophugus (GORD).

Diagnosis

This is made at endoscopy: this is usually undertaken for symptoms of acid regurgitation or heartburn. A few patients with Barrett's may present with a bleed from their upper gastrointestinal tract, or develop a stricture, making food difficult to swallow.

Treatment

This is usually with medication (proton pump inhibitors) to reduce gastric acid secretion. Some patients undergo keyhole anti-reflux surgery (LARS).

Complication of Barrett's

In a very small percentage of patients with Barrett's the cells may become premalignant (dysplasia). If unchecked this can lead to development of cancer of the oesophagus. The risk, however, of cancer developing is very low: in a recent study from Northern Ireland of 2,969 patients with Barrett's oesophagus the rate of malignancy was 0.26% per year.

Surveillance

The cells of Barrett's oesophagus are biopsied every 1-3 years at endoscopy: if these cells show signs of pre-malignant change (dysplasia) the frequency of endoscopic biopsy may increase.

Treatment of dysplasia

This can be by surgical removal of the oesophagus (oesophagectomy) in advanced (high grade) dysplasia. Other methods, not yet in common usage, include "burning" the Barrett's lining with an Argon light or use of photodynamic therapy (PDT). Both these treatments are performed endoscopically.

Useful paper; Murray L, Watson P, Johnson B, et al; Risk of developing adenocarcinoma in Barrett's, British Medical Journal 2003; 327:534-5.

Outcome of surgery >>