Barrett’s oesophagus

Barrett’s oesophagus is a condition caused by stomach acid and bile moving backwards (reflux) into the oesophagus.

The oesophagus (gullet) is the long, muscular tube connecting your mouth to your stomach. 

Barrett’s oesophagus is a potentially serious condition because there’s a small chance it can lead to oesophageal cancer.

Barrett’s oesophagus most commonly occurs when someone has gastro-oesophageal reflux disease (GORD or GERD). But you can also develop Barrett’s oesophagus without having GORD.

GORD is when stomach acid and bile flow backwards into your oesophagus and damages the lining at the bottom part of it.

This leads to the lining changing from a pink colour, like the lining of your mouth, to a red, like the lining of your bowel.

In some people, GORD also triggers a change in the cells lining your oesophagus. This change from normal cells to abnormal cells is the condition called Barrett’s oesophagus.

Barrett’s oesophagus doesn’t cause symptoms. But because Barrett’s oesophagus is closely linked to GORD, people with Barrett’s oesophagus may show symptoms related to GORD.

Signs and symptoms of GORD include: 

• Frequent heartburn
• Acid reflux (when stomach acid comes back up into the mouth and causes an unpleasant, sour taste)
• Oesophagitis (a sore, inflamed oesophagus)
• Bad breath
• Bloating and belching
• Feeling or being sick
• Pain when swallowing or difficulty swallowing

What are the chances of Barrett’s oesophagus developing into oesophageal cancer? 

GORD is common, but only 1 in 10 people with acid reflux or heartburn symptoms develop Barrett’s oesophagus. 

Barrett’s oesophagus causes no problems for 9 out of 10 people who develop it. However, the remaining 1 in 10 people with Barrett’s oesophagus could eventually develop oesophageal cancer.

How does Barrett’s oesophagus develop into cancer? 

Barrett’s oesophagus develops into oesophageal cancer in three stages:

Stage 1 – Low-grade dysplasia

An abnormal collection of cells appear in the lining of the oesophagus. At this stage, they’re not cancerous, but they could turn cancerous at a later date.

Stage 2 – High-grade dysplasia 

Severely abnormal cells are present in the inner lining of the oesophagus and are starting to appear at a faster rate. 

Stage 3 – Oesophageal cancer 

The abnormal cells in the lining of the oesophagus divide out of control and may spread to other parts of the body.

It’s important to note that not everyone with Barrett’s oesophagus will develop low-grade dysplasia or move through these three stages. 

Most people with low-grade dysplasia do not develop oesophageal cancer, and it’s thought only half of people with high-grade dysplasia will develop oesophageal cancer.

The only way to confirm a diagnosis of Barrett’s oesophagus is with a test called an upper endoscope. 

This involves a long, thin, flexible tube being passed through your mouth, down your throat and into your oesophagus.

At the end of the endoscope is a light and digital camera that lets your consultant look for any changes in the lining of your oesophagus.

Your consultant will also use tiny surgical instruments at the end of the endoscope to take a sample of tissue (biopsy) from the lining of your oesophagus.

This sample is examined under a microscope so an accurate diagnosis can be made.

If you’re diagnosed with Barrett’s oesophagus with no pre-cancerous cells, you usually don’t need treatment at this stage. But you may be monitored to check for any change in this situation.

If you have Barrett’s oesophagus and pre-cancerous cells are detected, you may be recommended a treatment called HALO radiofrequency ablation. 

This treatment has been specifically developed to use high-frequency radio waves to destroy abnormal Barrett’s oesophagus cells.