Barrett’s Oesophagus

What is Barrett’s Oesophagus?
Barrett’s oesophagus is the name given to a change in the normal lining of the lower end of the oesophagus from normal ‘squamous’ lining to an intestinal-type, mucus secreting ‘columnar’ lining.  It is thought that this change occurs due to chronic inflammation and damage caused by exposure to acid and other secretions from the stomach in patients who have gastro-oesophageal reflux (GORD).  Barrett’s does not, in itself, cause any symptoms but most people with Barrett’s will have symptoms of reflux.

Barrett’s oesophagus is considered important because people who have Barrett’s are at increased risk of developing cancer in the oesophagus.  The absolute risk of cancer is relatively small and the majority of people with Barrett’s oesophagus (up to 95%) do not ever develop cancer in the oesophagus.

How is Barrett’s oesophagus diagnosed?
Barrett’s oesophagus can only be diagnosed by taking biopsies from the part of the affected oesophagus at the time of a gastroscopy.  The diagnosis is often suspected at the time of gastroscopy (endoscopy) based on the appearance of the oesophagus but confirmation with biopsies examined under the microscope is usually performed.

There are no widely accepted recommendations regarding who should have a gastroscopy to check for Barrett’s oesophagus.  Firm recommendations do not exist because of the lack of strong evidence that screening for Barrett’s prevents people from dying from oesophageal cancer.

Many gastroenterologists will recommend gastroscopy to check for Barrett’s in people over the age of 40 who have had reflux symptoms for many years.

How is Barrett’s oesophagus treated?
The treatment options for Barrett’s oesophagus include treatment of gastro-oesophageal reflux, surveillance for development of complications and occasionally eradication of the affected part of the oesophageal lining. 

Treatment of gastro-oesophageal reflux with medications that prevent the production of acid by the stomach usually prevents the symptoms of reflux but may be recommended even in the absence of these symptoms as it may prevent the development of cancer. 

Regular checks on the oesophagus ‘ surveillance’ with gastroscopy is usually recommended to identify those at highest risk of developing oesophageal cancer or to detect cancers early when treatment is more likely to be successful.  How frequently the oesophagus should be checked will depend on the findings at your previous gastroscopies.

Treatment to eradicate the lining of the affected part of the oesophagus is recommended for some patients at highest risk of developing oesophageal cancer.  This is based largely on how abnormal the biopsies from the oesophagus look when examined under a microscope.  Radio-frequency ablation is currently the most widely accepted treatment but other treatments are under evaluation in clinical trials.