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Dyspepsia and peptic ulcers
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What is Barrett's oesophagus?
Barrett’s oesophagus is a change that happens at the lower end of
the gullet. It means that the cells lining the inside of the
oesophagus have changed to be more like those of the stomach
(so called ‘columnar-lined epithelium’, because the cells become
rectangular and stacked in columns, rather than the flat, horizontal
cells that are usually seen in the oesophagus).
Why does it happen?
Almost certainly Barrett’s oesophagus happens because of
long-standing gastro-oesophageal reflux. It is more common in
people with a hiatus hernia, in men, and in overweight people.
What symptoms does it cause?
Barrett’s oesophagus per se does not cause symptoms. The most likely symptoms are heartburn and regurgitation cause by the underlying GORD. Interestingly, a proportion of people with Barrett’s oesophagus have never had any reflux symptoms (and are diagnosed by chance due to an endoscopy for other reasons).
I have heartburn, am I likely to have Barrett’s oesophagus?
Your chances of having Barrett’s oesophagus are much less than your chances of not having it. Approximately 10% of people with persistent reflux symptoms have Barrett’s oesophagus. This risk is considered high enough to make it important to have persistent reflux symptoms checked out by a doctor.
How is it diagnosed?
Barrett’s oesophagus is diagnosed by a camera examination (gastroscopy, otherwise called upper GI endoscopy, or OGD). The diagnosis can usually be made visible, but confirmation biopsy samples must also be taken.
Is Barrett’s oesophagus dangerous?
The importance of Barrett’s oesophagus is that there is a risk of it developing into oesophageal cancer. The risk of this happening has been a matter of debate, but is probably small and in the region of 0.3% per year (3 in 1000 people with Barrett’s develop a cancer every year).
Can I reduce the risk of Barrett’s oesophagus turning into cancer?
Stopping smoking, and drinking alcohol in moderation is likely to help, as is losing weight if you have a few extra pounds around the waist.
If you have Barrett’s oesophagus you should take proton pump inhibitor tablets (PPIs, e.g. omeprazole, lansoprazole). This is because acid reflux is thought to cause Barrett’s, and so reduction in acid appears to be a logical treatment.
Finally, it is often important to undergo regular ‘surveillance’ endoscopy examinations.
What is endoscopic surveillance of Barrett’s oesophagus?
In many people with Barrett’s oesophagus regular endoscopy is conducted for surveillance (keeping an eye on it) purposes. Ideally, this is not with an aim to identify cancer early, but rather to detect early changes (dysplasia) that are associated with an increased risk of turning into cancer. To do this properly it should be done by an expert endoscopist who is experienced at surveying Barrett’s oesophagus, and with good equipment (a high-definition gastroscope). If these abnormalities are detected, they can be treated using endoscopic techniques called endoscopic mucosal resection and radio frequency ablation.
Surveillance is usually done every 2 years, or sometimes more frequently in certain cases.
What do I do if I am worried about Barrett’s oesophagus?
It is always best to speak to your doctor, who may refer you to a gastroenterologist with expertise in the area.