Barrett's oesophagus is a condition which affects the lower gullet (oesophagus). In this condition, the cells that line the affected area of the oesophagus change shape and behaviour. This change in cells can be seen at endoscopy (see figures 1 and 2 below).

The cells of Barrett's oesophagus are not cancerous. However, compared to a population with normal gullets, patients with Barrett's oesophagus have a higher risk of developing cancer of the oesophagus. Accurate measurement of the level of increased risk is difficult. In the UK, it is estimated that the risk of developing oesophageal cancer in patients with Barrett's is approximately 1 in 100 per year (Almond, Barr and Jankowski, 2014). This is why patients diagnosed with Barrett's oesophagus are advised to have regular (surveillance) endoscopies to detect any abnormalities in the cells of the oesophagus, by taking regular biopsies from the Barrett's.

If 'normal' Barrett's cells develop further abnormal changes, such as dysplasia, then a different set of advice and treatment is advised, which can be found here.

Figure 1. Appearance of Barrett's oesophagus at endoscopy. Source: UHBW NHS Foundation Trust.

Figure 2. Annotated picture of Barrett's oesophagus at endoscopy. Source: UHBW NHS Foundation Trust.

Symptoms

Barrett's oesophagus does not cause symptoms. One of the main factors causing Barrett's oesophagus to occur 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.

References

Max Almond, Hugh Barr and Janusz Jankowski, 'Barrett's oesophagus', chapter in 'Oesophagogastric Surgery: a companion to specialist surgical practice.' Edited by S Michael Griffin, Simon A Raimes, Jon Shenfine. 2014.

The diagnosis of Barrett's oesophagus can only be made with a combination of an upper GI endoscopy and samples of cells taken at the time of the endoscopy, called biopsies.

Upper GI endoscopy - diagnostic

This is a common procedure involving the insertion of a thin tube with a camera on the end through the mouth into the oesophagus, stomach and first part of the small bowel called the duodenum. This test is important to look for a range of problems such as acid damage or an ulcer. It is a very routine procedure, but as with any test there are benefits and risks, even though the risks are very low. More information on this procedure, its benefits and risks are available here.

Barrett's oesophagus has a particular appearance on upper GI endoscopy. If the person performing the endoscopy thinks the appearances suggest Barrett's oesophagus, they will take small samples of tissue (called biopsies) which will then be sent to the laboratory to be looked at under a microscope in the next 2-4 weeks. This will then confirm whether or not Barrett's oesophagus is present.

Upper GI endoscopy - surveillance

Once somebody has been found to have Barrett's oesophagus, if they are suitable, they will then be booked for further upper GI endoscopies on a regular basis to monitor for further changes or the development of cancer. These may be carried out every 2 to 5 years, depending upon how much Barrett's they have on their endoscopy.

A surveillance endoscopy involves careful examination of the lining of the oesophagus for any lumps or nodules. Sometimes, different types of lighting technique or dyes may be used to help with this examination. It also involves taking multiple biopsies to check for changes in the cells, for example to 'pre-cancerous' or dysplastic cells. Depending upon how long the area of Barrett's oesophagus is, this examination can take longer than a normal diagnostic endoscopy. However, it is very important to have a careful look to make sure any subtle changes are detected.

Anti-acid medication

People with Barrett's oesophagus are advised to take regular anti-acid medication. Research has suggested that taking anti-acid medication may reduce the risk of change from 'normal' Barrett's oesophagus to pre-cancerous dysplasia or cancer itself. Therefore, we advise taking anti-acid medication even if you do not have symptoms of acid reflux.

The most commonly used drugs to lower acid levels are called Proton Pump Inhibitors (PPIs). These include omeprazole and lansoprazole, amongst others. These types of drugs are some of the most widely used in the NHS because symptoms of acid reflux are so common.

Lifestyle changes

Being overweight or obese is associated with reflux, Barrett's oesophagus and oesophageal cancer. It is therefore important to lose weight if you are overweight or obese.

Smoking cigarettes and drinking alcohol are also associated with acid reflux. Stopping smoking and avoiding alcohol will help control any symptoms and reduce the level of acid going back up into the oesophagus.

Adopting these changes will also have an important beneficial effect on your overall health.

Here are some useful links to other sources of information and support for patients who have Barrett's oesophagus. However, as these are external websites, we are not responsible for the accuracy of any content which may change over time.

Cancer Research UK:

https://www.cancerresearchuk.org/about-cancer/other-conditions/barretts-oesophagus/about-barrett%27s

Macmillan Cancer Support:

https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/pre-cancerous-and-genetic-conditions/barretts-oesophagus

Guts UK Charity:

https://gutscharity.org.uk/advice-and-information/conditions/barretts-oesophagus/