Barrett’s Oesophagus

Barrett's esophagus is a condition where the lining of the esophagus changes and begins to resemble the lining of the small intestine more than that of the esophagus. This occurs in the area where the esophagus connects to the stomach.

It is widely believed that chronic inflammation caused by gastroesophageal reflux disease (GERD) primarily leads to Barrett's esophagus. Interestingly, the duration or severity of GERD symptoms, such as heartburn, does not seem to affect the likelihood of developing Barrett's esophagus. However, those who have experienced GERD for a long time or since a young age are more susceptible to Barrett's esophagus.

Although most individuals with Barrett's esophagus will not develop cancer, a few may experience precancerous tissue changes called dysplasia. This transformation has a higher chance of progressing into esophageal cancer.

Who Should Be Screened for Barrett’s Oesophagus?

Barrett's esophagus is observed to be twice as common in men as in women. It usually affects middle-aged Caucasian men who have experienced heartburn for many years. There is no unanimous consensus among experts regarding the screening criteria. However, some suggest screening for individuals over 50 who have experienced persistent heartburn or have relied on heartburn medications for several years.

Diagnosing Barrett’s Oesophagus

If your doctor suspects you have Barrett's esophagus, they will perform an endoscopy to capture images of your esophagus. They will use an endoscope, which has a camera and light source that projects images onto a monitor, to examine any changes in the esophageal lining. If any suspicious regions are found, a biopsy may be necessary to conclusively diagnose Barrett's esophagus. This procedure only slightly extends the length of the endoscopy and is usually painless and rarely results in complications.

Treatment Options for Barrett’s Oesophagus

Although medicines and surgeries can effectively manage symptoms of GORD, they cannot reverse Barrett's esophagus or entirely eliminate the risk of cancer. However, there are treatments that can destroy Barrett's tissue, which may help reduce the risk of cancer. These treatments include applying heat (such as radiofrequency ablation, thermal ablation with argon plasma coagulation, and multipolar coagulation), cold energy (cryotherapy), or light combined with specific chemicals (photodynamic therapy).

What is Dysplasia?

Dysplasia is a stage prior to cancer that can only be diagnosed through microscopic examination of tissue. If diagnosed, it is classified as "high-grade," "low-grade," or "indefinite for dysplasia."

It is recommended to have any dysplasia diagnosis confirmed by two different pathologists. If dysplasia is present, your doctor may suggest more frequent endoscopies, removal of Barrett's tissue, or even surgery on the esophagus, depending on the severity of dysplasia and your overall health.

Endoscopy for Monitoring Dysplasia

Although the likelihood of developing oesophageal cancer in patients with Barrett's oesophagus is relatively low (about 0.5% annually), it is important to regularly undergo upper endoscopy checks with biopsies of the affected tissue in order to diagnose the condition. If the initial biopsies show no dysplasia, the endoscopy with biopsy should be repeated roughly every three years. If dysplasia is observed, your doctor will advise on subsequent steps to take.