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Barrett’s oesophagus: Causes, symptoms and diagnosis

What is Barrett's oesophagus?

Barrett's oesophagus occurs as a complication of chronic gastro-oesophageal reflux disease ( GORD). GORD refers to the reflux of acidic fluid from the stomach into the oesophagus (the swallowing tube or gullet), and is classically associated with heartburn. The condition is named after a surgeon, Norman Barrett, who described the condition.

Why is there so much interest in Barrett's oesophagus?

The reason for the great interest in Barrett's oesophagus is that it is associated with an increased risk of cancer of the oesophagus. The type of cancer that occurs in patients with Barrett's is adenocarcinoma. The usual cancer of the oesophagus is squamous-type carcinoma, which arises from the squamous lining that is normally present in the oesophagus. The connection between adenocarcinoma of the oesophagus and Barrett's oesophagus is now clear. In fact this type of tumour is increasing in frequency in most countries in the Western hemisphere.

However the good news is that the cancer occurs in relatively few patients with Barrett's oesophagus. The main challenge in this condition is to watch for early warning signs of cancer in these patients by taking biopsies (small samples) during endoscopy at regular intervals. This practice is called surveillance and is similar, in principle, to the surveillance in women for cancer of the cervix, known as cervical screening (smear tests).

Barrett's oesophagus at a glance

  • Barrett's oesophagus is a complication of chronic (long lasting) and usually severe gastrointestinal reflux disease (GORD), but occurs in only a small percentage of people with GORD.
  • The diagnosis of Barrett's oesophagus rests upon seeing (at an endoscopy) a pink oesophageal lining (mucosa) that extends a short distance up the oesophagus from the gastro-oesophageal junction and finding columnar cells on biopsy of the lining.
  • There is a small but definite increased risk of cancer of the oesophagus (adenocarcinoma) in people with Barrett's oesophagus.
  • The treatment for Barrett's oesophagus is in general essentially the same as for GORD. However treatment of GORD either medically (acid-suppression medication) or surgically (e.g. fundoplication) does not result in the disappearance of Barrett's oesophagus or in a reduced cancer risk.
  • Dysplasia is a cellular process that occurs in the Barrett's mucosal lining of the oesophagus and indicates a heightened risk of cancer. Periodic endoscopic oesophageal biopsies are done in Barrett's to look for the dysplasia.
  • The frequency of endoscopic biopsy surveillance in Barrett's varies from person to person. Generally, when dysplasia cells are found biopsy may be performed every 3 to 6 months, and then if no dysplasia cells are found every 2 to 3 years.
  • The management of high-grade dysplasia involves repeating the biopsies right after the high grade is discovered to rule out an accompanying cancer. Oesophagectomy - surgical removal of the affected part of the oesophagus - is the standard therapy for high-grade dysplasia and cancer, but other procedures are available including laser therapy, radiofrequency ablation, and photodynamic therapy (PDT).
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