Barrett's Oesophagus

Barrett's Oesophagus (or Barrett's mucosa) is the term given to a change which occurs in the lining of the lower oesophagus. It occurs in a small proportion of patients with longstanding gastro-oesophageal reflux. Normally the oesophagus is lined with squamous (flat) cells, which makes the oesophagus smooth and slippery to aid the passage of food. For reasons which are not understood, in some patients with longstanding reflux, the squamous lining is replaced by columnar (tall) cells, similar to those which occur normally in the stomach. This can be identified by taking biopsies at the time of upper gastrointestinal endoscopy (gastroscopy).

Frequency in the Community

A small proportion of patients with Barrett's Oesophagus develop cancer (adenocarcinoma) in the Barrett's lining after many years. This usually develops slowly over a period of some years and can be predicted by the finding of pre-cancerous changes (dysplasia) on biopsies, thus allowing surgery at an early stage before the cancer has spread.

Cause

It is not known why some patients with acid reflux develop Barrett's mucosa whereas others do not. Nor is it known why some will progress to cancer.

Symptoms

There are no particular symptoms for Barrett's Oesophagus.

Diagnosis

Barrett's Oesophagus can only be diagnosed at endoscopy and confirmed by taking biopsies (tiny samples of tissue).

Treatment/Therapy

The ideal prevention is to treat gastro-oesophageal reflux before it leads to Barrett's Oesophagus. Patients with proven Barrett's Oesophagus are usually treated with proton pump inhibitor medication such as omeprazole, esomeprazole, pantoprazole, and rabeprazole, or sometimes with surgery. If dysplasia (pre-cancerous change) developes in the biopsies sometimes this will require treatment by surgery and other techniques.