What is Barrett’s oesophagus?

Barrett’s oesophagus is a complication of acid reflux whereby the lining of the oesophagus changes from the normal pinkish-white, flat (squamous) cells to the bright salmon/red coloured rectangular (columnar) cells found further down the gastrointestinal tract.

It is caused by the stomach contents and acid repeatedly leaking (refluxing) back up the lower oesophagus, causing inflammation and abnormal cell formation. This can vary from mild (low grade dysplasia) to severe (high grade dysplasia) and if left untreated can, in rare cases, increase the risk of cells turning cancerous.

What are the risks of Barrett’s oesophagus?

Although Barrett’s oesophagus can progress to cancer, this risk is very small and only occurs in around 1 in 200 (0.5%) patients with Barrett’s oesophagus per year.

What are the symptoms of Barrett’s oesophagus?

There are no specific symptoms of Barrett’s oesophagus but it is more likely if you have had symptoms of acid reflux, or heartburn, for ten years or more.
Barrett’s oesophagus is sometimes detected when an upper GI endoscopy is performed for another unrelated condition.

Factors that predispose people to developing Barrett’s oesophagus include:

  • Male
  • Aged over 50 years
  • Obesity
  • Smoking
  • Chronic acid reflux for over 10 years, or symptoms of acid reflux more than 3 times a week

How is Barrett’s oesophagus diagnosed?

Two criteria have to be fulfilled to diagnose Barrett’s oesophagus:

  • Endoscopic confirmation of abnormal, salmon pink lining in the lower oesophagus, near to the oesophago-gastric junction.
  • Pathologic identification of cells with the specialised intestinal metaplasia characteristic. A specialist gastroenterology pathologist is required for accurate interpretation of the findings.

How is Barrett’s oesophagus managed?

How the condition is managed depends on whether there is any dysplasia or not.

With only mild, or no dysplasia, management will include:

  • Lifestyle changes, as for chronic acid reflux
  • Symptom control with antacid medications
  • Anti-reflux surgery may be preferred by some patients for symptom control
  • Regular monitoring with endoscopy, to look out for worsening of cell changes

High grade dysplasia is managed more intensively because of the greater risk of progression to oesophageal cancer. It may include some, or all, of the following:

  • Intensive endoscopic monitoring every 6 months, with multiple tissue sampling at 1cm intervals
  • Endoscopic mucosal resection – removing the affected oesophageal lining through the endoscopy
  • Photodynamic therapy (PDT) – to kill the irregular oesophageal cells
  • Oesophageal resection in suitable candidates

There are other treatment options currently undergoing clinical trials. You will be advised of the most suitable option(s) for you.

Please ensure you consult a healthcare professional before making decisions about your health.