Barrett’s oesophagus: how acid reflux can have nasty consequences

Barrett’s oesophagus is a condition of the gullet (oesophagus) that affects people who suffer from gastro-oesophageal reflux (sometimes abbreviated to GORD or GERD). Top Doctors talks to Dr Stuart Bloom, a gastroenterologist from University College London and expert on Barrett’s oesophagus, who tells us about this digestive condition.

What is Barrett’s oesophagus?

Barrett’s oesophagus was described by Norman Barrett in the 1950s. It refers to a condition where the bottom end of the oesophagus is lined by a tissue usually found in the stomach – the body’s attempt to protect itself against acid refluxing from the stomach into the oesophagus. The normal lining of the oesophagus, made of cells called squamous cells, is replaced by a lining made of columnar cells. These cells can take on the characteristics of the intestine (pathologists call this intestinal metaplasia) and in a small proportion of cases this intestinal metaplasia can develop warning signs of cancer. By watching for this (a process called surveillance) specialists can treat the condition early and prevent progression to cancer.

What causes Barrett’s oesophagus/acid reflux?

This isn’t completely understood, as Barrett’s oesophagus doesn’t occur in all people with acid reflux. Normally, the sphincter or muscle at the lower end of the oesophagus stays contracted except when swallowing, preventing reflux of acid from the stomach into the gullet. In some people, the sphincter loses its tone and allows acid to come up from the stomach –this is gastro-oesophageal reflux, and is felt symptomatically as heartburn or sometimes a bitter tasting fluid in the back of the throat (water brash)

Some people seem to be prone to reflux: nicotine caffeine and alcohol relax the sphincter muscle and predispose the individual to reflux, and being significantly overweight is also a predisposing factor.

Does Barrett’s oesophagus have any harmful effects?

It can do, although only in about 1 per 100 patients per year.  We get nervous about Barrett’s because there is a small risk of developing a pre-cancerous condition called dysplasia, and so we like to keep a close watch on the lower oesophageal mucosa using regular endoscopy.

What are the symptoms of Barrett’s oesophagus?

There are no definite symptoms of Barrett’s oesophagus, but there are symptoms of acid reflux. In most patients, Barrett’s oesophagus is caused by acid reflux, but not all patients with acid reflux have Barrett’s. The symptoms of acid reflux are heartburn, water brash (regurgitating liquid into the throat) and sometimes problems with food sticking on swallowing. These symptoms can be effectively treated with acid suppressant therapy, with tablets called histamine receptor antagonists or proton pump inhibitors. These tablets can provide effective short term relief but should not be taken for longer than 6 weeks without a definite diagnosis being made – this is done by an endoscopy.

How do you treat Barrett’s oesophagus?

Once Barrett’s oesophagus is proven, the main aspects of treatment are acid suppression, reversal of any correctable risk factors (including smoking, excess alcohol intake, or being overweight), and careful surveillance with endoscopy to make sure it does not progress. If there are signs of progression to significant dysplasia or pre-cancer, special techniques can be used to remove the abnormal lining or epithelium in the affected area. These include a type of therapy called radiofrequency ablation, which is delivered by an endoscope. This is basically cauterization; a current is passed through a plate, which destroys the Barrett’s epithelia, and allows normal cells (lining) to replace it.

The rate of progression of Barrett’s oesophagus to dysplasia is low – about 1 case per 100 every year. Many patients just need regular surveillance of their Barrett’s and never need any further treatment.