Barrett’s oesophagus is the disease in which the lining of the lowest part of the oesophagus is replaced by an abnormal lining which resembles the lining of the small intestine.
Barrett’s oesophagus occurs in response to longstanding severe gastro-oesophageal reflux disease (GORD). Most patients with Barrett’s oesophagus therefore have severe reflux symptoms such as heartburn, regurgitation (the feeling of fluid rising in the chest) or the sensation of food getting stuck during swallowing (dysphagia). Somewhat surprisingly, some patients with Barrett’s oesophagus do not have severe or even any reflux symptoms despite having reflux disease.
Barrett’s oesophagus is a clinical and research interest of Professor Lord’s. For further information on Professor Lord’s Barrett’s oesophagus research laboratory please see: Research and Publications.
Barrett’s oesophagus is diagnosed by endoscopy (also called gastroscopy) in which a flexible tube is passed through the mouth into the oesophagus whilst the patient is under sedation. Barrett’s oesophagus is diagnosed if the doctor performing the endoscopy sees the characteristic reddish coloured lining in the lower oesophagus and if the pathologist finds the typical Barrett’s oesophagus cells when examining biopsies from the lower oesophagus under the microscope. Many patients are misdiagnosed as having Barrett’s oesophagus when they do not in fact have the disease. It can therefore be worthwhile in some cases to have a repeat endoscopy if you have been told that you have Barrett’s oesophagus.
The importance of Barrett’s oesophagus is two-fold. Firstly, it indicates severe reflux disease which needs maximum reflux treatment. Secondly, Barrett’s oesophagus is a condition which can rarely progress to a form of cancer called oesophageal adenocarcinoma or Barrett’s cancer. The statistics for oesophageal adenocarcinoma are amongst the worst of all cancers. Overall, large studies show that only 15 to 20% of patients diagnosed with this cancer will survive beyond five years. Fortunately the chance of surviving for patients who are able to undergo surgery are much better than this.
Patients with Barrett’s oesophagus are often quite naturally concerned about their risk of cancer. It is therefore important to note that the great majority of patients with Barrett’s oesophagus will never develop Barrett’s cancer and their risk of developing this cancer seems to be only 1 in 500 per year. This risk is slightly higher for patients with low grade dysplasia, which is when the cells in the Barrett’s oesophagus area have become more irregular in shape and contain more serious genetic abnormalities. The risk of cancer is much higher in patients with Barrett’s oesophagus with high grade dysplasia, who need treatment to prevent cancer developing.