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This information is about a condition known as Barrett's oesophagus. In a small number of people, Barrett's oesophagus may gradually develop into cancer of the lower part of the gullet (oesophagus)|.
The oesophagus (gullet) is the muscular tube that carries food from the mouth to the stomach. Barrett's oesophagus is a condition in which 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 go on to develop cancer (about 1 in 100 each year).
The digestive system
View a large copy of the digestive system image|
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 chest from the abdomen.
The stomach produces acid, and the stomach juices contain bile and proteins, which help digest food. The stomach is lined by tissue that is resistant to acid, but the oesophagus isn't. The acid may inflame and irritate the oesophagus and, in some people, will 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 (10%) people 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 men and in people over 50.
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.
Some people have no symptoms at all and the Barrett's oesophagus is discovered during tests for other medical conditions.
The most common symptom is ongoing heartburn and indigestion. Other symptoms include feeling of sick (nausea|), being sick (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 have a single episode of vomiting blood), it's advisable to visit your GP.
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.
The endoscopy may be carried out by a doctor or specialist nurse, and it 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 2–4 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.
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 three months and 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 is aimed at reducing the reflux and controlling symptoms.
Sometimes it's possible to reduce the reflux without treatment. 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. If you suffer with reflux at night, it can help to raise the head of the bed.
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 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 it's very safe to take long term.
Surgery| can be carried out to help strengthen the valve at the bottom of the oesophagus, to prevent further acid reflux or to remove the affected area.
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 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 reduce acid reflux. Very occasionally a hiatus hernia can affect the chest area. In this situation (known as a complicated hiatus hernia) a chest operation may be necessary.
If a biopsy shows that there are continuing changes in the cells lining the lower end of the oesophagus that may progress to cancer, your specialist may suggest that you consider having surgery to remove the affected area.
Sometimes, only the affected area of the lining of the oesophagus needs to be removed. This type of surgery is known as endoscopic mucosal resection. 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 photodynamic therapy| or endoscopic treatments.
More extensive surgery is sometimes 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 only be given 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.
A number of other endoscopic treatments can be used to destroy abnormal cells in the lining of the oesophagus:
Despite its name, cold coagulation uses heat (not cold) to destroy abnormal cells. A heated probe is placed near the affected area to get rid of the abnormal cells.
This is a newer treatment that is only done in specialist centres. It may be used for the treatment of high-grade dysplasia in Barrett's oesophagus. It uses laser light sources combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy abnormal cells.
Other techniques for treating Barrett's oesophagus include argon plasma coagulation, radiofrequency ablation|, multipolar electrocoagulation and endoscopic plication.
Your specialist can tell you more about these treatments and whether any of them may 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 are diagnosed with a condition such as Barrett's oesophagus. You may have concerns about whether or not you need surveillance, medication or perhaps an operation. 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 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. Many people find it helpful to talk things over with their doctor or nurse. Close friends and family members can also offer support.
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.
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:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.