Definition The oesophagus is the tube that connects the throat to the stomach. Barrett's oesophagus is a condition that occurs when column-shaped cells replace the normally flat and scale like cells of the lower oesophagus. This change in the cells is probably caused by stomach acids splashing up into the oesophagus reflux over a long period of time.
What is going on in the body? The oesophagus is connected to the stomach by the oesophageal sphincter. This is a muscular ring. Normally, this muscle performs two major functions. It opens to allow food to pass into the stomach. It also closes to keep the contents of the stomach from splashing back up into the oesophagus.
If this sphincter weakens or relaxes, gastro-oesophageal reflux, or reflux, occurs. This means that the contents of the stomach flow back up into the oesophagus. The lining of the oesophagus is not made for this kind of abuse. Therefore, after being exposed to stomach acid over a long period of time, the lining of the oesophagus changes. Cells that stand upright and produce mucous sometimes replace the flat cells. This change in the lining of the lower oesophagus is called Barrett's oesophagus.
This condition occurs mainly in Caucasian men who are 40 to 50 years of age. It is found in about 10% of patients who have symptoms of reflux, or heartburn. This condition is seen with oesophagoscopy. Oesophagoscopy or upper endoscopy/gastroscopy is a procedure in which an endoscope is inserted into the mouth. An endoscope is a thin tube with a light and camera attached to it. The endoscope is passed down into the oesophagus. This allows a doctor to look at the inside lining of the oesophagus directly through the endoscope.
What are the signs and symptoms of the condition? Barrett's oesophagus itself does not cause symptoms. However, people with this condition may have symptoms from reflux.
The most common symptom of reflux is burning pain under the breastbone or in the upper abdomen, often called heartburn. This pain may increase when eating, bending over, or lying down. The pain occurs regularly after overeating, while bending over, or lying down. Antacids usually relieve the pain. Pain may increase at night or causes a person to wake up during the night. Other symptoms of reflux include:
belching a sour-tasting liquid
regurgitating stomach acids up into the throat
difficulty in swallowing
What are the causes and risks of the condition? Reflux, or the splashing of stomach contents back up into the lower oesophagus, causes this condition.
The main risk of this condition is that the abnormal cells may turn into cancer.
What can be done to prevent the condition? The best way to prevent this condition may be to diagnose and treat reflux as early as possible.
How is the condition diagnosed? The only way to make this diagnosis is to look at the lining of the oesophagus through an endoscope and remove a small piece of it. The small piece can then be examined with a microscope. This is called oesophagoscopy with biopsy. This condition is diagnosed when the biopsy shows upright cells instead of the normal flat ones.
What are the long-term effects of the condition? A person who has Barrett's oesophagus has a 30 to 40 times greater risk of getting cancer of the oesophagus than a person who does not have this condition, but only 1-3% of people with Barrett's oesophagus will develop cancer.
What are the risks to others? Barrett's oesophagus is not transmitted from one person to another.
What are the treatments for the condition? After the diagnosis is made, a doctor will prescribe medications and procedures to treat reflux. Proton-pump inhibitors, such as omeprazole, lansoprazole, pantoprazole, or rabeprazole, are the drugs of choice for treating reflux. However, these drugs cannot cure the condition. That is, they cannot change the abnormal cells back into normal cells. All drugs can do is to heal the damage to the oesophagus caused by stomach acid and prevent more damage.
Unfortunately, there is nothing that can prevent the cells of Barrett's oesophagus from changing into cancer. Cancer does not always occur in people with this condition, but the risk is greatly increased. A person with this condition should have esophagoscopy with biopsy done regularly. This allows a doctor to see if the abnormal cells of Barrett's oesophagus are changing towards increasing dysplasia or have turned into cancer. If there is severe dysplasia or cancer present then surgery is often recommended.
What are the side effects of the treatments? Side effects may include:
side effects from medications used to treat reflux, such as allergic reactions or stomach upset. Specific side effects depend on the drug used.
complications of repeated oesophagoscopy with biopsy, which may include bleeding or infection.
What happens after treatment for the condition? The abnormal cells in this condition cannot be changed back into normal cells. The cells also cannot be stopped from changing into cancer. The only thing that can be done is to treat the reflux, so that no more normal cells change into abnormal ones.
Treatment may not end, as repeated oesophagoscopy with biopsy for life is often advised.
How is the condition monitored?
A person should keep in touch with his or her doctor.
People with heartburn or difficulty in swallowing that lasts for more than a few days should call their doctor.
People with symptoms that do not improve after treatment should call their doctor.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 1/03/2005 Contributors Potential conflict of interest information for reviewers available on request
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