What is Barrett's oesophagus?

This page is about Barrett's oesophagus. There is information about

What Barrett's oesophagus is
The risk of oesophageal cancer
Treatment for Barrett's oesophagus

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.

These cell changes are caused by the stomach juices coming back up through the valve at the top of the stomach (acid reflux). The acid in these juices irritates the lining of the food pipe. Over a long period of time, the cell type can begin to change and the columnar cells replace the flat, squamous cells. This is probably the body responding to the irritation and trying to protect itself. But the more cells are damaged and replaced, the more chance there is that one of them will gather all the genetic changes that can turn it into a cancer cell. This is explained in more detail in the about cancer section.

Barrett's oesophagus is now recognised as a risk factor for cancer of the oesophagus. It is most likely to be diagnosed in people who have a long history of burning indigestion – a sign of acid reflux. So if you have a lot of indigestion, and have had for a long time, it is important to see your doctor. But remember that only 1 or 2 people in 100 with Barrett's oesophagus (1 to 2%) will go on to develop oesophageal cancer.

People who are known to have Barrett's oesophagus are usually seen regularly by a doctor and have regular examinations of the oesophagus (endoscopies). This doesn't prevent oesophageal cancer, but should pick it up early on. 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 and help to study 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.

If your cells are very abnormal, your doctor may suggest surgery. It might be possible to strengthen the valve at the lower end of the oesophagus with a small operation. Or your doctor may suggest having an endoscopic mucosal resection to remove the area of abnormal cells. In some cases doctors may suggest removing the lower part of your oesophagus to stop a cancer from developing. This is quite a major operation. There is information about surgery to the oesophagus in the oesophageal cancer section.

Your doctor may suggest having radiofrequency ablation. You may have this on its own to destroy the abnormal cells, or after an endoscopic mucosal resection incase there are any abnormal cells left behind.

Your doctor might also suggest a type of treatment that uses light to treat the abnormal cells. This treatment is called photodynamic therapy (PDT). You might have this after an endoscopic mucosal resection. You can find more information about PDT for Barrett's oesophagus in the oeosophageal cancer research section.

Researchers in the USA have had promising results using cryotherapy to treat Barrett's oesophagus once the oesophageal cells have started to change. They put a small tube into the throat, and use liquid nitrogen to freeze these cells before they can become cancerous. The damaged cells will fall off, allowing normal cells to replace them. This treatment is being used in some hospitals in the USA, but more research is needed.

There is an organisation called Barrett's Oesophagus Campaign, who promote research into this area and produce some useful leaflets that are available from their website.