Barrett Oesophagus is a condition involving a change in the lining of the oesophagus, the muscular tube that carries food from your mouth to your stomach. This alteration can arise from chronic acid reflux.
What is Barrett Oesophagus?
Barrett Oesophagus involves a transformation at the cellular level within the lower part of the oesophagus. Normally, the oesophagus is lined with flat, pale pink cells known as squamous cells. In Barrett’s, these squamous cells are replaced by simple columnar epithelium, which resembles the cells found in the small intestine, a change referred to as intestinal metaplasia. These columnar cells are rectangular and arranged in a single layer, often interspersed with goblet cells that produce mucus. This cellular change occurs in the lower oesophagus, near where it connects to the stomach, and can appear salmon-pink during an endoscopy.
Causes and Development
The primary cause of Barrett Oesophagus is chronic gastroesophageal reflux disease (GERD), where stomach acid repeatedly flows back into the oesophagus. This persistent exposure to acidic stomach contents, and sometimes bile, can damage the normal squamous cell lining. Over time, the oesophageal cells adapt to this irritation by transforming into a more acid-resistant, intestinal-like lining. This cellular reprogramming is thought to be a protective mechanism, as intestinal lining offers greater defense against digestive enzymes and acids.
Several factors increase the likelihood of developing Barrett Oesophagus. These include being male, being over 50 years old, and having a long history of acid reflux symptoms, often for at least 10 years. Other contributing factors are obesity, especially with fat concentrated around the waist, a family history of Barrett Oesophagus or oesophageal cancer, and smoking. While GERD is a major contributor, some individuals with Barrett’s report few or no reflux symptoms, a phenomenon sometimes called “silent reflux.”
Identifying and Monitoring the Condition
Barrett Oesophagus is diagnosed through an upper gastrointestinal endoscopy. During this procedure, a thin, flexible tube with a camera is guided down the throat into the oesophagus and stomach. The endoscopist looks for areas where the normal pale pink squamous lining has been replaced by the reddish, columnar-lined tissue characteristic of Barrett’s.
To confirm the diagnosis and assess for precancerous changes, small tissue samples, called biopsies, are taken from the suspicious areas. These biopsies are then examined under a microscope by a pathologist to identify intestinal metaplasia and check for dysplasia, which refers to abnormal cell growth. Surveillance involves regular endoscopic examinations with biopsies to monitor the condition over time.
Managing Barrett Oesophagus
Managing Barrett Oesophagus involves various strategies to reduce acid reflux and address any abnormal cellular changes. Lifestyle modifications are often the first step, including dietary adjustments to avoid foods that increase stomach acid or relax the lower oesophageal sphincter. This might involve limiting fatty foods, alcohol, peppermint, coffee, and acidic items like tomatoes, as well as avoiding large meals and remaining upright after eating. Maintaining a healthy weight and quitting smoking are also beneficial in reducing reflux.
Medical treatments involve proton pump inhibitors (PPIs), which are effective in suppressing stomach acid production. PPIs help heal oesophageal inflammation and provide long-term control of GERD symptoms, and their consistent use may decrease the risk of dysplasia. For cases where dysplasia is present, endoscopic therapies are considered to remove abnormal tissue. Radiofrequency ablation (RFA) uses heat energy to destroy the Barrett’s tissue, while endoscopic mucosal resection (EMR) involves removing visibly abnormal areas of tissue. These procedures aim to replace the abnormal lining with healthy squamous cells and are often combined with ongoing PPI therapy.
Understanding the Cancer Risk
Barrett Oesophagus carries an increased risk of developing oesophageal adenocarcinoma, a type of cancer that originates from glandular cells. While it is considered a precancerous condition, the progression to cancer occurs in only a small percentage of individuals. The annual risk of developing oesophageal adenocarcinoma is less than 1%. The lifetime risk is estimated to be around 5%, which is comparable to the lifetime risk of colon cancer.
The most significant marker for an increased risk of cancer is the presence of dysplasia, which refers to abnormal cell growth observed in biopsies. Dysplasia is categorized as low-grade, meaning the cells are slightly abnormal, or high-grade, indicating more significant cellular changes. High-grade dysplasia suggests a greater potential for progression to cancer. Regular monitoring through endoscopy and biopsies is important for early detection of these changes. Early identification and intervention for dysplasia can improve outcomes and help prevent the development of oesophageal adenocarcinoma.