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Barrett's oesophagus

 

What Barrett's oesophagus is

In Barrett's oesophagus, the cells of the food pipe have started to change. The cells of the lining (epithelium) of the food pipe are normally flat. They are known as squamous cells. In Barrett's oesophagus they have changed to a rectangular type of epithelial cell called a columnar cell. This cell type is usually found lining the digestive organs lower down in the digestive system, in the small and large intestines (the ileum and the colon).

People with Barrett's oesophagus may have cells that are growing abnormally. Doctors call this dysplasia. The cells may show low grade or high grade dysplasia. The grade of a cell is what it looks like under a microscope. The less normal the cells look, the higher the grade. Cells with low grade dysplasia are mildly abnormal. Cells with high grade dysplasia are more abnormal.

 

Causes of Barrett’s oesophagus

The cell changes in the food pipe are caused by stomach juices coming back up through the valve at the top of the stomach (acid reflux). The acid in the juices irritates the lining of the food pipe. Over a long period of time, the cell type can begin to change.  Column shaped cells replace the usual flat, squamous cells.  As more cells are damaged and replaced, the risk increases that one of them will turn into a cancer cell. This is explained in more detail in the about cancer section.

Your risk of having acid reflux is higher if you  

  • Are overweight
  • Smoke
  • Drink large amounts of alcohol
  • Eat spicy or fatty foods

Researchers are looking into the causes of Barrett’s oesophagus including

  • Why some people develop it and others don’t
  • Whether there is an increased risk of developing it if someone in your family has it
  • Whether there is a link between being very overweight (obesity) and developing Barrett’s oesophagus

You can find out about trials for Barrett’s oesophagus on our clinical trials database.

 

Symptoms of Barrett’s oesophagus

Many people don’t have any symptoms and the cell changes in the oesophagus are found when they have tests for something else.  

Long term burning indigestion is the most common symptom. Indigestion is very common and doesn’t usually mean there is anything seriously wrong. But if you have ongoing indigestion, see your doctor to get it checked out.

Some people also have difficulty swallowing food. You should see your doctor as soon as possible if you have this.  

A less common symptom is food coming back up from the stomach into the food pipe.

If you have symptoms you may need a test to look at the inside your food pipe and stomach. This is called an endoscopy. We have more information about endoscopy.

 

The risk of oesophageal cancer

We know that Barrett's oesophagus can increase your risk of cancer of the oesophagus. Barrett’s oesophagus is most likely to be diagnosed in people who have a long history of burning indigestion. So it is important to see your doctor if you have had burning indigestion for a long time. But remember that only between 1 and 5 people in every 100 with Barrett's oesophagus (1 to 5%) will go on to develop oesophageal cancer.

If you have Barrett's oesophagus you will need to see your doctor regularly. You will also need to have regular examinations of the inside of your food pipe. These are called endoscopies. They don't prevent oesophageal cancer, but should pick it up early on when there is a better chance of successful treatment.

A number of research trials are trying to find the best way to monitor people at risk of Barrett’s oesophagus and oesophageal cancer.

Cancer Research UK is supporting the BEST2 study. This study is looking at how well a new test called a Cytosponge works. You swallow a capsule with a thread attached to it. Inside the capsule is a sponge. When the capsule reaches your stomach, the outer covering of the capsule dissolves. A nurse then pulls the sponge out. It collects cells for testing as it passes up your food pipe. 

The aim of the Cytosponge test is to diagnose Barrett’s oesophagus. The BEST2 study is also trying to find particular cell changes that show that people have a higher risk of Barrett’s oesophagus becoming cancer. The researchers hope this will help them to know which people with Barrett's oesophagus may need close monitoring or treatment. 

The video below shows what is like to have the Cytosponge test.

View a transcript of the video showing you what what happens when you have a Cytosponge test. (opens in a new window)

The BOSS study is looking at whether it is better to monitor people with Barrett's oesophagus every 2 years or to wait until they have a change in their symptoms.

The TIME study is using a new type of endoscopy called ETMI (Endoscopic Tri Modal Imaging). It hopes to see if ETMI can find cell changes in people with Barrett’s oesophagus. The researchers will also study samples of tissue (biopsies) taken during the endoscopy to look for features (markers) linked to abnormal cell changes that lead to cancer.

You can read about other clinical trials looking at screening and diagnosis of Barrett's oesophagus on the oesophageal cancer research page

 

Treatment for Barrett's oesophagus

Treatment aims to lower the amount of acid reflux you have and to remove any damaged areas. Treatments include

Medicines

Your doctor will suggest medicines to reduce the amount of acid your stomach produces. These include drugs called proton pump inhibitors, for example, omeprazole. These medicines help to control the symptoms of indigestion. You may need to take these tablets for as long as they control your symptoms. But you may be able to reduce the dose after a while. These medicines control symptoms for most people.

Treatment by endoscopy

Most people have treatment through an endoscope. An endoscopy is when the doctor puts a flexible tube called an endoscope down your throat. The endoscope contains a camera so the doctor can see inside the food pipe. There are different types of treatment you can have through an endoscope including

Endoscopic surgery

If your doctor can see an abnormal area or a nodule containing abnormal cells, they may suggest surgery to remove it. They call this operation an endoscopic mucosal resection or an EMR. Your doctor will give you a sedative to make you sleep. Then they remove the abnormal area using a thin wire called a snare.

Radiofrequency ablation

Your doctor may suggest having radiofrequency ablation (RFA) if your cells are very abnormal. You may have this on its own to destroy the abnormal cells. Or you may have RFA after endoscopic surgery, in case there are still abnormal cells in the area. We have more information about radiofrequency ablation.

Light treatment (photodynamic therapy)

This treatment is called photodynamic therapy (PDT). It uses light to treat abnormal cells. People sometimes have this after a endoscopic surgery. You can find out about PDT for Barrett's oesophagus in the oesophageal cancer research page. Doctors don’t commonly use PDT because people become very sensitive to light for a few weeks afterwards. The light sensitivity can be difficult to cope with.

Cryotherapy

Cryotherapy means destroying tissue by freezing it. Researchers in the USA have had promising results using cryotherapy to treat Barrett's oesophagus. They put a small tube into the throat and use liquid nitrogen to freeze the area containing the abnormal cells. The damaged cells fall off, allowing normal cells to replace them. This treatment is used in some hospitals in the USA. But we need more research to find out how helpful cryotherapy is for Barrett’s oesophagus.

We have more information about cryotherapy that you may find helpful.

Surgery

If your symptoms are not well controlled with medicines, a surgeon may be able to strengthen the valve at the lower end of your oesophagus. This means having a small operation. The operation is called fundoplication (pronounced fun-doh-plik-ay-shun).

In some cases, if other treatments have not worked, your doctor may suggest removing the lower part of your food pipe to stop a cancer from developing. This is quite a major operation. We have more information about surgery to the oesophagus.

 

Coping with Barrett’s oesophagus

It can be difficult to live with a condition like Barrett’s oesophagus and the uncertainty it can bring. People react differently and there is no right or wrong way to cope. Finding out about your condition and its treatment can help some people feel more in control.

You may find the following organisations helpful

If you want to find people to share experiences with online, you could use our online forum CancerChat.

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Updated: 7 January 2014