Barrett's oesophagus

Barrett’s oesophagus is when the cells lining the lower part of your oesophagus (gullet) gets damaged by acid and bile repeatedly coming up from your stomach. 

What is it?

The acid made by your stomach is noxious stuff that is made to digest food and kill any germs entering your stomach. The lining of the stomach is specially made so that it is protected from the harmful effects of acid, but the oesophagus is not. This means that when acid refluxes into the gullet it becomes inflamed and the symptoms recognised as heartburn may develop. 

After many years of reflux an adaptive change occurs in the lining of the oesophagus that makes it come to resemble the lining of the stomach. This change makes the lining more resistant to the effects of stomach acid, so heartburn symptoms may improve, and is called Barrett’s oesophagus or Barrett’s change of the oesophagus. It is important because it is recognised that the majority of oesophageal cancers develop from Barrett’s oesophagus.

It is uncommon and occurs only in about 5 percent of people with longstanding reflux. It is important because it is associated with a 30 to 100 times increased risk of developing a cancer of the oesophagus.

What are the symptoms of Barrett’s oesophagus?

There are no symptoms that are specific for Barrett’s oesophagus. Many patients with the condition will complain of longstanding heartburn but there is no way of differentiating between a patient with simple heartburn and one with Barrett’s oesophagus. Odd as it may seem some patients with Barrett’s oesophagus never experience any heartburn symptoms at all. 

Less commonly a patient with Barrett’s oesophagus may complain of difficulty swallowing (dysphagia), vomiting blood, passing black tarry stools and unexplained weight loss. These are sinister symptoms and raise the possibility of oesophageal cancer.

What is the cause of Barrett’s oesophagus?

Barrett’s oesophagus is caused by longstanding reflux of acid from the stomach into the oesophagus. There is a ring of muscle at the junction of the oesophagus and stomach (sometimes called the lower oesophageal sphincter), it relaxes to allow food to pass into the stomach from the oesophagus, and then clamps shut to prevent acid entering the gullet.

Left untreated, chronic reflux can lead to severe heartburn (the chest pain can be intense enough to resemble a heart attack), narrowing of the oesophagus, bleeding, Barrett’s oesophagus and even cancer.

Reflux symptoms may be worsened by excess alcohol intake and cigarette smoking. Barrett’s oesophagus itself is more common in men and in people over the age of 60.

How is Barrett’s oesophagus diagnosed?

The condition is diagnosed by endoscopy and biopsy of the oesophagus. 

The procedure provides your doctor with a direct view of the oesophagus and stomach. Barrett’s change of the oesophagus is visible to the naked eye; the normally pale lining of oesophagus becomes reddened to resemble the colour of the stomach lining. An oesophageal cancer or stricture would also be seen if present.  

Find out more about endoscopy procedures at Intus.

What is the treatment of Barrett’s oesophagus?

Treatment for Barrett’s oesophagus begins by controlling oesophageal reflux with simple lifestyle changes: more exercise, weight loss, avoidance of foods that aggravate heartburn, stopping smoking, taking antacids and elevating the head of your bed to prevent reflux during sleep.

These measures are normally combined with medical and sometimes surgical treatment.