Barrett's oesophagus is a condition that in a small number of people may gradually develop into cancer of the lower part of the gullet (oesophagus).
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having your treatment.
What is Barrett's oesophagus?
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The oesophagus (gullet) is the muscular tube that carries food from the mouth to the stomach (see diagram below). Barrett's oesophagus is a condition where abnormal cells develop on the inner lining of the lower part of the oesophagus.
Barrett's oesophagus is not in itself a cancerous condition, but over a period of time it can occasionally lead to cancer developing in the lower part of the oesophagus. A cancer develops when cells in the affected area continue to grow and reproduce, and become increasingly abnormal. Approximately 1-2 out of every 200 people in the UK have Barrett's oesophagus. However, very few people with this condition (about 1 in 100 each year) go on to develop cancer.
Causes of Barrett's oesophagus
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This is when the valve at the lower end of the oesophagus (gullet) is weak and allows the stomach contents to 'splash' up into the oesophagus. Reflux of acid is very common and many people experience symptoms from time to time.
Certain factors can make people more likely to have reflux. These include:
Reflux is often also caused by a hiatus hernia. A hiatus hernia occurs when a small piece of the stomach is displaced and pokes through the sheet of muscle (the diaphragm) that divides the tummy area (abdomen) from the chest.
GORD (gastro-oesophageal reflux disease)
This is when stomach acid irritates the oesophagus. The stomach produces acid to help digest food. While the stomach is lined by a issue that’s resistant to acid, the oesophagus isn't. The acid can inflame and irritate the oesophagus and, in some people, cause symptoms of pain and heartburn. This is often referred to as gastro-oesophageal reflux disease (GORD) or reflux oesophagitis.
Not everyone who has acid reflux will develop Barrett's oesophagus. Up to 1 in 10 people (10%) with acid reflux will go on to develop Barrett's oesophagus. This is more likely to happen in people who have had severe reflux symptoms for many years, in people over 50 and in men.
A small number of people will experience changes in the cells of the oesophagus. These changes in the cells are sometimes called dysplasia. They are pre-cancerous changes. Dysplasia can be either low-grade or high-grade, depending on how abnormal the changes are (with high-grade being the most abnormal).
Signs and symptoms of Barrett’s oesphagus
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Some people have no symptoms at all and Barrett's oesophagus is discovered during tests for other medical conditions.
The most common symptom is ongoing heartburn and indigestion. Other symptoms include feeling sick or being sick (nausea or vomiting) and difficulty swallowing food. Less commonly, there may be blood in the vomit. Some people have pain when swallowing food.
If you experience any of these problems for more than two weeks, or if you ever vomit blood, you should visit your GP.
How Barrett’s oesphagus is diagnosed
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Your GP will examine you and may refer you to the hospital for a procedure known as an endoscopy to examine the lining of your oesophagus. (Endoscopies can also be used to deliver treatments).
The endoscopy may be carried out by a doctor or specialist nurse, and enables the oesophagus to be examined using a thin flexible tube called an endoscope. Usually small samples of cells (biopsies) are taken, which can then be examined in a laboratory to see if they are normal.
You can usually have an endoscopy as an outpatient, but occasionally an overnight stay in hospital is necessary. You will be comfortably positioned on a couch on your side. You may be given the choice of having a local anaesthetic spray to numb the back of your throat (and reduce any discomfort during the test), or a sedative to make you feel sleepy. The sedative is usually injected into a vein in the arm. The doctor or nurse then passes the endoscope down your oesophagus.
An endoscopy can be uncomfortable but it isn't painful. After a few hours the effect of the sedative will wear off and you'll be able to go home. If you've had the local anaesthetic spray to numb the back of your throat, you may need to stay in hospital until the anaesthetic has worn off. This usually takes about 1-2 hours and you shouldn't try to swallow anything during this time. The nurse or doctor will tell you how long to wait before you try to swallow anything.
If you have had sedation, you shouldn't drive for several hours after the test and, if possible, you should arrange for someone to travel home with you. Some people have a sore throat following the procedure. This is normal and usually disappears after a couple of days. If it doesn't, contact your doctor at the hospital. You should also tell your doctor if you have any chest pain, breathlessness or blood in your vomit.
Often, people with Barrett's oesophagus are advised to have their condition checked at regular intervals in order to pick up any further changes. This is known as surveillance and usually involves regular endoscopies and biopsies. At present, it's not known how useful surveillance is. This is because of the small number of people with Barrett's oesophagus who actually go on to develop oesophageal cancer. It will be some time before the benefits and possible disadvantages of regular endoscopies become clear.
Depending on the degree of change in your condition, if any, and the policy at your hospital, the endoscopies may be repeated at intervals between every three months and every three years. It may be helpful to discuss this with your specialist.
If you're having regular endoscopies and you notice any change or worsening of your symptoms between appointments, it's a good idea to contact your specialist.
Treatment for Barrett’s oesophagus
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Treatment for Barrett’s oesophagus is aimed at reducing the acid reflux and controlling symptoms.
Sometimes it's possible to reduce the reflux by making some lifestyle changes.
Losing weight (if necessary), stopping smoking, or drinking less alcohol may help. Eating small meals at regular intervals, or avoiding foods that aggravate the symptoms, can also help reduce reflux. It can help to have your last meal of the day 2-3 hours before bedtime and avoid late night snacks if possible. This is because eating encourages the stomach to produce more acid, which can cause you to have reflux at night. If you suffer with reflux at night, it can help to raise the head of the bed.
Medicines to reduce acid
You may be given medicines, such as proton pump inhibitors (PPI) or histamine receptor blockers, to decrease the production of stomach acid. This will help reduce any symptoms that you have. Once the symptoms are controlled, the dose of your PPI may be reduced to a level that keeps the symptoms from recurring. PPIs are often taken for life, and are very safe to take in the long term.
This is an operation to strengthen the valve at the bottom of the oesophagus. During the operation, the top of the stomach (the fundus) is wrapped and stitched around the lower end of the oesophagus. This procedure reinforces (strengthens) the lower end of the oesophagus, and should help reduce acid reflux. Fundoplication is often done using a laparoscope (often known as keyhole surgery), and only involves small cuts in the abdomen. Less often it may involve a large incision in the abdomen (a laparotomy).
An operation to repair a hiatus hernia may also help to reduce acid reflux. Very occasionally a hiatus hernia can affect the chest area (known as a complicated hiatus hernia). In this situation, a chest operation may be necessary.
Removing the affected area
If a biopsy shows that there are continuing changes in the cells lining the lower end of the oesophagus, which may progress to cancer, your specialist may suggest that you consider having surgery to remove the affected area. There are two main approaches:
endoscopic mucosal resection
Endoscopic mucosal resection
The aim of this type of surgery is to remove only the affected area of the lining of the oesophagus without damaging the rest of the oesophagus. It's done via an endoscopy and can be done as a day case or sometimes with an overnight stay. This type of surgery may be followed by other endoscopic treatments (see below).
Sometimes more extensive surgery is needed. This involves removing the section of the oesophagus that contains the abnormal cells. The stomach is then joined to the remaining length of the oesophagus. After this operation, you're likely to spend a short period of time in the intensive care unit. You will have a drip put into a vein in your hand or arm until you're able to eat and drink again.
You may also have a fine tube, called a nasogastric (NG) tube, inserted down your nose and into your stomach or small intestine to allow any fluids to be removed. This will stop you feeling sick and help the area of the operation heal.
You may feel afraid to swallow for a short period of time. You may also have a bad taste in your mouth. Mouthwashes can help relieve this.
At first, you'll probably be given only sips of liquid until your doctor is satisfied that the join in the oesophagus is healing. It will be a few days before you're able to drink normally. Gradually, you'll also be able to eat normally again.
Some surgeons will also place a small feeding tube directly into the small bowel at the time of surgery, to feed you while you recover. This is usually removed after you have started to swallow normally.
Endoscopic treatments use endoscopes to deliver therapy. They can be used to destroy abnormal cells in the lining of the oesophagus.
Radiofrequency ablation (RFA)
RFA uses heat to destroy abnormal cells. A probe called an electrode is used to apply an electrical current (radiofrequency) to the abnormal area. The electrical current heats the abnormal cells to a high temperature, which destroys (ablates) them. This treatment is usually done under a local anaesthetic with sedation.
The main side effects can include mild pain or discomfort, feeling generally unwell and high temperatures. RFA is most often an option for people who have high-grade dysplasia (see the section on GORD, under causes, above). Your doctor can give you more detailed information about whether it might be helpful in your situation.
Other endoscopic techniques
Other ways of treating Barrett's oesophagus include argon plasma coagulation, multipolar electrocoagulation and cryotherapy.
Your specialist can tell you more about these treatments and whether any of them might be appropriate for you. It's important to remember that these techniques aren't widely available and long-term data (research results) on their success is not yet available.
It's often difficult to find information and support when you’re diagnosed with a condition such as Barrett's oesophagus. You may have concerns about which is the right treatment option for you. It's important to discuss these concerns with the doctors and nurses caring for you. You may also find the organisations listed below helpful.
You may have many different emotions, including anger, resentment, guilt, anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition.
Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it. Our cancer support specialists can give you information about counselling in your area.
Barrett's Oesophagus Campaign
Barrett's Oesophagus Campaign is an organisation set up to promote research into Barrett’s oesophagus, a condition that can develop into cancer of the oesophagus. Its website has useful information, including downloadable leaflets.
publishes patient information on any aspect of digestive problems.
Oesophageal Patients Association
Oesophageal Patients Association gives support and information to people affected by oesophageal cancer.
This section has been compiled using information from a number of reliable sources, including:
Tobias J, Hochhauser D. Cancer and its management. 6th edition. 2010. Wiley-Blackwell
National Institute for Health and Clinical Excellence (NICE). Dyspepsia: Managing Dyspepsia in Adults in Primary Care. 2004.
National Institute for Health and Clinical Excellence (NICE). Interventional procedure guidance 344: Epithelial radiofrequency ablation for Barrett's oesophagus. 2010.
Rees J R, et al. Treatment for Barrett’s Oesophagus. The Cochrane Library. Published online Jan 2012.
Spechler S J. Management of Barrett's oesophagus. www.uptodateonline.com Sept 2012 (accessed Oct 2012).
With thanks to Dr Mark Wilkinson, who reviewed this information.
Thank you to all of the people affected by cancer who reviewed what you're reading and have helped our information to grow.
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