Barrett's Oesophagus
What is Barrett's Oesophagus?
It is the a condition in which the lining of the oesophagus (the gullet) changes to become more like the lining of small intestine. This start at the lower end of the oesophagus where it joins the oesophagus and extends to a variable extent upward.
Why does it occur?
Barrett's oesophagus develop as a result of chronic inflammation due to GastroOesophageal Reflux Disease (GORD). The chance of this happening is related to the duration of the reflux rather than the intensity and frequency of the reflux symptoms.
How common is Barrett's Oesophagus?
About 20% of adults experience symptoms of GORD at least twice a week. Barrett's oesophagus develops in 10 to 15% of these patients.
What are the symptoms of Barrett's Oesophagus?
Barrett's oesophagus does not produce any specific symptoms on its own. Patients usual have symptoms of GORD (acid reflux) like heartburn, regurgitation of fluid or food, swallowing difficulties, belching, sore throat, cough, hoarseness of voice, and wheezing.
Why is it important to know if I have Barrett's Oesophagus?
Barrett's oesophagus is a precancerous condition, meaning that patients with Barrett's oesophagus have a higher than average risk of developing cancer of the oesophagus. Adenocarcinoma of the oesophagus, the most common type of cancer of the oesophagus, arises from regions of Barrett's mucosa.
Most patients with Barrett's oesophagus will not develop cancer. In some patients, however, a precancerous change called dysplasia will develop. This precancerous change is more likely to develop into cancer.
What is the risk of cancer in patients with Barrett's oesophagus?
The risk of cancer in patients with Barrett's oesophagus is 40 times higher than normal. Although the risk of cancer is increased, the actual chance of getting cancer is quite small. Each year about 0.5-1% of patients with Barrett's oesophagus develop cancer.
Patients with Barrett's oesophagus without dysplasia have a low risk. Those with dysplasia, however, have a higher risk. High-grade dysplasia is in fact an early cancer and about 40% of patients will have an invasive cancer when the oesophagus is examined fully after surgery.
How to test for Barrett's Oesophagus?
Barrett's oesophagus is diagnosed a gastroscopy and a biopsy. Gastroscopy (upper endoscopy) is performed under sedation as a day procedure. A flexible tube called gastroscope is passed through the mouth and into the oesophagus, stomach and duodenum. A camera at the end produce live images that are displaced on a monitor. The Barrett's lining has a distinct appearance from the normal lining. A biopsy (a sample of tissue) is taken with a small biopsy forceps to make a definitive diagnosis.
How is Barrett's Oesophagus treated?
There is no need for routine treatment for Barrett's oesophagus. Life style changes and medical treatment will relief the symptoms of acid reflux in majority of patients. These, however, do not have any important effects of Barrett's oesophagus. Ablative therapy where the Barrett's lining is destroyed by a variety of method is a promising technique but still not widely used.
There is growing evidence that antireflux surgery may help prevent the development of cancer in patients with Barrett's oesophagus, however, this is still controversial.
Patients with confirmed high grade dysplasia should be treated as patients with cancer of the oesophagus and undergo surgical resection.
Do I need check-ups for my Barrett's Oesphagus?
Patients with Barrett's oesophagus should have gastroscopy performed every 1 to 3 years. This is called surveillance gastroscopy. This is aimed at finding of dysplasia changes and oesophageal cancer at any early stage.