A patient’s story
Sarah, 62, managed daily heartburn with over-the-counter tablets for years, assuming it was a normal part of ageing. When swallowing became slightly uncomfortable, she sought a specialist opinion.
An endoscopy revealed changes in her oesophageal lining caused by persistent acid exposure. With a clear diagnosis and a monitoring plan in place, she now manages her condition effectively and has peace of mind regarding her future health.
What is Barrett’s oesophagus?
Barrett’s oesophagus is a condition where the cells lining the lower part of the oesophagus (gullet) change due to damage. The normal flat cells are replaced by abnormal cells that resemble the lining of the intestine.
This change is primarily a complication of gastro-oesophageal reflux disease (GORD). While the condition itself does not always cause symptoms, it increases the risk of developing oesophageal adenocarcinoma, a type of cancer. However, with proper monitoring, this risk can be managed safely.
Symptoms of Barrett’s oesophagus
Barrett’s oesophagus does not typically cause unique symptoms. Instead, patients usually experience the symptoms of underlying acid reflux.
Common signs include:
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Persistent heartburn or indigestion
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Acid regurgitation into the mouth
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Difficulty swallowing (dysphagia)
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Chest pain or discomfort
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A chronic cough or hoarse voice
Some patients may have silent reflux and experience no obvious symptoms despite cell changes occurring.
What causes the condition?
The primary cause is chronic exposure to stomach acid. When the valve between the stomach and oesophagus is weak, acid flows back up, causing inflammation and damage.
Over time, the body attempts to repair this damage by changing the type of cells lining the oesophagus.
Risk factors include:
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Long-standing GORD (typically over 5 years)
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Being male and over the age of 50
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Being overweight or obese
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Smoking
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A family history of Barrett’s oesophagus or oesophageal cancer
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Presence of a hiatus hernia
How is Barrett’s oesophagus diagnosed?
Diagnosis requires a visual examination of the oesophagus. The primary investigations include:
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Gastroscopy (endoscopy): A thin, flexible tube with a camera is passed into the oesophagus to examine the lining.
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Biopsy: During the gastroscopy, small tissue samples are taken and examined under a microscope.
The biopsy confirms the diagnosis and checks for dysplasia, which refers to precancerous changes in the cells.
Treatment and management
Treatment focuses on controlling acid reflux to prevent further damage and monitoring cell changes for any progression towards cancer.
Medical and lifestyle management
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Proton pump inhibitors (PPIs): Medications that significantly reduce stomach acid production.
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Dietary changes: Avoiding triggers such as alcohol, spicy foods, and caffeine.
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Weight management: Reducing pressure on the stomach.
Surveillance
Patients typically undergo regular gastroscopies (every 2 to 5 years) to monitor the tissue. This allows for early detection of any cancerous changes.
Interventional treatments
If dysplasia (precancerous changes) is identified, treatments may include:
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Radiofrequency ablation (RFA): Heat energy is used to destroy abnormal cells.
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Endoscopic mucosal resection (EMR): Removal of abnormal tissue via an endoscope.
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Anti-reflux surgery: Procedures such as fundoplication to physically prevent acid reflux.
When to seek medical advice
You should see a specialist if you have:
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Heartburn for more than five years
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Symptoms that do not improve with medication
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Difficulty swallowing or food sticking
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Unexplained weight loss
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Vomiting blood or dark stools