Norman ‘Pasty’ Barrett, an Australian-born, Eton educated surgeon, first described Barrett’s oesophagus in the 1950s. It is important because about 5% of affected people develop cancer of the oesophagus. However, regular testing and early treatment of pre-cancer are now available.
What is Barrett’s oesophagus?
The oesophagus (gullet) is the food pipe that connects the mouth to the stomach. The cells normally lining the oesophagus are very similar to those on our skin. In Barrett’s oesophagus, cells similar to those of the stomach replace the normal cells. The length of oesophagus involved is variable, from one or two centimetres to ten or more.
What causes Barrett’s oesophagus?
Barrett’s oesophagus is thought to result from prolonged reflux, due to a defective anti-reflux mechanism (see gastro-oesophageal reflux disease). Most patients have a hiatus hernia. The acid from the stomach causes persistent inflammation of the gullet (oesophagitis) and, possibly in conjunction with bile refluxing from the small intestine, triggers the change in oesophageal cell type.
Barrett’s oesophagus is most common in white, middle aged men, particularly those who are overweight or smoke.
Do I have Barrett’s Oesophagus?
1 – 4% of the general population and up to 10% of people with symptoms of acid reflux have Barrett’s oesophagus. Many of those affected have symptoms of gastro-oesophageal reflux disease, but there may be no symptoms at all.
Barrett’s oesophagus can only be diagnosed by gastroscopy. Small, safe and painless biopsy samples of the oesophagus are taken to look for precancerous changes.
What is the treatment for Barrett’s Oesophagus?
The first aim of treatment is to reduce the amount of acid reflux.
Patients are advised to lose weight and stop smoking if appropriate. Foods and fluids known to make reflux worse should be avoided (chocolate, caffeine, fatty foods and alcohol).
Acid reducing drugs such as proton pump inhibitors (e.g. omeprazole, lansoprazole) are usually given to reduce the amount of acid produced in the stomach. Less acid in the stomach means less acid in the reflux. Patients with severe reflux who do not respond to medication may need anti-reflux surgery.
New techniques can destroy the rogue oesophageal cells and encourage re-growth of the usual oesophageal lining. The most promising of these destroys the abnormal cells with heat (radio-frequency ablation), and is used mainly for patients who have developed pre-cancerous changes. This is called the BarrX ‘Halo’ method.
Do patients with Barrett’s Oesophagus need monitoring?
Yes. The British Society of Gastroenterology recommends that patients with Barrett’s oesophagus have a gastroscopy every two years. This involves a careful visual inspection of the affected oesophagus, with multiple biopsies taken for microscopic examination. More frequent examinations are needed if there are pre-cancerous changes.
London Digestive Health supports Barrett's Oesophagus Campaign, the only national charity dedicated to the prevention of cancer from Barrett’s Oesophagus and the support of people living with the disease.