About

Dysplastic Barrett's oesophagus is a condition when the cells of 'normal' Barrett's oesophagus develop further abnormal changes. Sometimes these changes can be seen at endoscopy (see figures 1 and 2 below), but sometimes they are only found once small samples (biopsies) are taken from the gullet. These changes are called dysplasia and may be described as 'pre-cancerous'. Dysplasia may be graded as low or high grade to describe the severity of the changes. Dysplastic Barrett's oesophagus is not cancer. However, the risk of developing cancer is higher than in 'normal' Barrett's. Because the risk of cancer is higher, the team will try to remove these abnormal cells using various treatments which are described on the treatment page, here.

Information about 'normal' Barrett's oesophagus is available here.

Figure 1. Barrett's with abnormal dysplastic-looking area. Source: UHBW NHS Foundation Trust.

Figure 2. Dysplastic-looking area marked. Source: UHBW NHS Foundation Trust.

Barrett's oesophagus and dysplasia can be considered as a spectrum of changes, as shown in the diagram below. Normally, the oesophagus has hard wearing lining of squamous cells. Barrett's is a change in the cells that increases the risk of developing oesophageal cancer, compared to having a normal squamous lining. When dysplasia is found, the risk of developing cancer increases further, compared with Barrett's oesophagus. High grade dysplasia has a higher chance of becoming cancer than low grade. These changes can end in the development of cancer from Barrett's oesophagus, with that particular type of cancer called adenocarcinoma.

Figure 3. Images from endoscopy and microscopy ranging from normal to oesophageal cancer. Reproduced with permission from the Royal College of Physicians, from 'Targeting care in Barrett's oesophagus', by S Zeki and R C Fitzgerald, in Clinical Medicine (2014); 14(6):s78-83.

Symptoms

Like 'normal' Barrett's oesophagus, dysplastic Barrett's oesophagus does not cause symptoms. One of the main factors causing Barrett's oesophagus is the reflux of acid from the stomach into the oesophagus. In some people, acid reflux does not cause significant symptoms. In some people, however, reflux can cause a burning sensation in the lower chest or upper abdomen, difficulty swallowing, or the regurgitation of acid or food into the throat. These symptoms are common in people with Barrett's oesophagus. However, they are caused by the acid going back up into the oesophagus, rather than the change in cells in the oesophagus.