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Barrett's Oesophagus

What is Barrett's Oesophagus?

The oesophagus (gullet) is the tube that carries food from the mouth to the stomach and is lined by cells similar to those that form the skin (squamous cells). In Barrett's Oesophagus the lining at the lower end of the gullet is found to have changed from being skin-like to being like the lining of the stomach. It was first identified in the early 1950's by a surgeon called Norman Barrett. The more scientific name is columnar-lined oesophagus (CLO). The lining may come to resemble that of the small intestine, described as 'intestinal metaplasia'.

What causes Barrett's Oesophagus?

The cause of the condition is not known, but it is believed to be linked to the 'reflux' of digestive juices from the stomach up into the gullet. Acid is present in the stomach to help digest food. Unlike the stomach, the oesophagus does not have a protective lining, so when it is repeatedly exposed to acid it may become inflamed and painful (oesophagitis). Sometimes contents from the duodenum (the first part of the intestine after the stomach), particularly bile, may also reflux into the oesophagus. A mixture of stomach and duodenal contents in the oesophagus is even more damaging than acid alone. The oesophagus usually heals with time and the lining returns to normal, but sometimes, and particularly if bile is present, it heals in a different way and the lining changes to appear more like the lining of the stomach or small intestine. How or why the change occurs is not known.

The condition appears to be more common in men, and people who are overweight. It has also been shown that smoking can accelerate changes to Barrett's Oesophagus.

What are the symptoms?

The condition is often symptomless. Most people diagnosed with Barrett's Oesophagus will have been examined because of symptoms associated with gastro-oesophageal reflux, which causes heartburn (a burning pain in the gullet, usually following a meal or when bending or lying down). Other symptoms may include a salty taste at the back of the mouth (termed water brash), hoarseness due to acid damaging the vocal cords and chest pain.

Barrett's Oesophagus can lead to complications such as ulcers in the gullet, bleeding, difficulty in swallowing due to a narrowing of the gullet (stricture), and occasionally cancer. The majority of people who have Barrett's Oesophagus have no serious consequences. Only a minority will develop any of the above complications.

How is Barrett's Oesophagus diagnosed?

The diagnosis is made by means of an endoscopy. This involves a thin flexible telescope being passed through the mouth, into the gullet and on into the stomach. A small sample is usually taken (biopsy) for examination. This will confirm the diagnosis and also highlight any complications that may be developing.

What is the treatment for Barrett's Oesophagus?

Three forms of treatment are available for Barrett's Oesophagus, although which treatment is best is, at present, unknown.

Medical treatment may be used, aimed mainly at suppressing the production of acid in the stomach and therefore reducing the amount of acid available to reflux into the oesophagus. The abnormal lining may be destroyed by laser or by heat energy. This is done using an endoscope, with the aim of encouraging the normal lining to re-grow. The weakened valve at the lower end of the oesophagus, which allows reflux to occur, may be strengthened by a surgical operation.

An international study is currently in progress to identify which of these treatments has the best long-term results in reducing complications and, particularly, the risk of developing cancer.

In general terms, patients can also take steps to help reduce reflux which may include:

  • losing weight, if necessary;
  • eating small meals at regular intervals;
  • allowing time for food to be digested before going to bed;
  • avoiding tight clothes and bending down after meals.

Smokers should stop smoking!

Does the condition need to be monitored?

Patients are often advised to undergo further examinations at regular intervals in order to identify any further changes in the oesophagus that might cause complications. However, despite the fact that Barrett's surveillance programmes are being set up in a number of hospitals in the UK, it is still not clear how beneficial this is, since only a small number of people may go on to have further complications. It will be some years before the advantages and disadvantages of repeated endoscopies become clear and a general policy can be developed.

New symptoms, such as difficulty in swallowing, vomiting blood or weight loss, require urgent medical attention.