What Is Barrett's Oesophagus?
Barrett’s oesophagus is a condition where the normal cells lining the oesophagus are altered due to repeated exposure to stomach acid. While Barrett’s oesophagus does not cause symptoms, it can increase the risk of developing oesophageal cancer over time. Therefore, it is important to understand its causes, symptoms, and available treatments.
What Causes Barrett's Oesophagus?
The primary cause of Barrett’s oesophagus is chronic gastroesophageal reflux disease (GERD). When the muscle at the end of the oesophagus doesn’t close properly, stomach acid can flow back into it, causing irritation and damage to its lining. Over time, this can replace normal squamous cells with specialised columnar cells, resulting in Barrett’s oesophagus.
What Are the Symptoms of Barrett's Oesophagus?
Barrett’s oesophagus itself doesn’t typically cause symptoms. However, individuals with this condition often experience symptoms related to gastroesophageal reflux disease (GERD), which is the primary underlying cause of Barrett’s oesophagus. These include –
- Heartburn – A burning sensation in the chest or throat, often after eating or lying down.
- Regurgitation – A feeling of acid or food coming back up into the throat or mouth.
- Chest Pain – Discomfort or pain in the chest, which may be mistaken for a heart-related issue.
- Difficulty Swallowing – Known as dysphagia, this can occur when inflammation narrows the oesophagus.
- Chronic Cough – Irritation in the oesophagus can trigger a persistent cough.
- Hoarseness or Sore Throat – Due to stomach acid irritating the throat and vocal cords.
How Is Barrett's Oesophagus Diagnosed?
Barrett’s oesophagus is diagnosed through an upper endoscopy procedure. During this procedure, a thin, flexible tube with a camera is passed through the mouth and into the oesophagus, allowing the doctor to examine the oesophageal lining visually. Biopsies may also be taken during the endoscopy to confirm the diagnosis and assess for cancerous changes.
What Are the Complications of Untreated Barrett's Oesophagus?
If left untreated, Barrett’s oesophagus can lead to serious complications, the most concerning of which is the development of oesophageal cancer.
- Esophageal Adenocarcinoma – Long-term untreated Barrett’s oesophagus significantly raises the risk of developing oesophageal adenocarcinoma, which originates in the cells lining the lower part of the oesophagus. The risk of cancer increases with the duration and extent of Barrett’s oesophagus, as well as the presence of dysplasia. In this condition, abnormal cells are found in the specialised columnar lining.
- Dysplasia Progression – Dysplasia, which refers to the presence of abnormal cells, is often a precursor to cancer. If left untreated, low-grade dysplasia can progress to high-grade dysplasia, increasing the likelihood of developing cancer.
- Strictures – Repeated inflammation and damage to the oesophagus can lead to scar tissue formation and narrowing of the oesophagus. This condition is known as a stricture, which can cause difficulty swallowing and may require medical intervention to widen the oesophagus.
Can Barrett's Oesophagus Be Prevented?
While preventing Barrett’s oesophagus may not always be possible, some steps can reduce the risk. Maintaining a healthy lifestyle, managing weight, and avoiding smoking can lower the likelihood of developing GERD, a significant risk factor for Barrett’s oesophagus. Additionally, managing GERD effectively with lifestyle changes and medications may help prevent the condition’s progression.
What Are the Medications for Barrett's Oesophagus?
The main goal of medication for Barrett’s oesophagus is to control GERD symptoms and reduce stomach acid production. Proton pump inhibitors (PPIs) are commonly prescribed to decrease acid levels in the stomach, which can help alleviate symptoms and prevent further damage to the oesophagus. Taking these medications as prescribed and following up with regular medical check-ups is essential.
Are Endoscopic or Surgical Treatments Available for Barrett's Oesophagus?
In patients who are found to have Barrett’s oesophagus with dysplasia (i.e. abnormal cells that can lead to cancer) ablative endoscopic treatments are available with radiofrequency ablation or cryotherapy to destroy the abnormal cells in the oesophageal lining. In more advanced cases endoscopic resection can remove these abnormal cells to confirm for the presence or absence of cancer. If cancer is found, surgical procedures may be considered to remove part or all of the oesophagus.
What Are the Tips and Precautions for Living with Barrett's Oesophagus?
Living with Barrett’s oesophagus requires lifestyle adjustments to manage GERD effectively and reduce the risk of complications. These may include maintaining a healthy diet, avoiding trigger foods that worsen symptoms, eating smaller meals, not lying down after eating, and raising the head of the bed while sleeping. It’s crucial to adhere to prescribed medications and follow the doctor’s recommendations for regular check-ups and surveillance endoscopies to monitor the condition closely.
