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Barrett's Oesophagus

Barrett's Oesophagus is a condition in which the oesophagus changes, so that some of its lining is replaced by a type of tissue similar to that normally found in the intestine. This lining is called intestinal metaplasia. Barrett’s Oesophagus is closely associated with Gastro-Oesophageal Reflux Disease (GORD), in which food and gastric liquids can enter the oesophagus from the stomach. It is presumed that the recurrent entry of these liquids into the oesophagus lead to the change of the oesophageal lining into that of intestinal Metaplasia.

While Barrett's Oesophagus may cause no symptoms itself, a small number of people with this condition develop a relatively rare but often deadly type of cancer of the oesophagus called Oesophageal Adenocarcinoma. This condition was described in the early 1950's by an Australian Surgeon Dr. Norman Rupert Barrett, who noticed that cells lining and extending from the lower oesophagus were secreting red mucus without causing inflammation. He believed these cells made up a tubular stomach in patient's who had a short oesophagus, however ten years later he discovered that the mucus secreting cells were an abnormality of normal cells, which now is known to lead to oesophageal cancer. Hence this condition is named in honour of Dr. Barrett.

Causes and Symptoms

The exact causes of Barrett's Oesophagus are unknown, but it is thought to be caused in part by the same factors that cause GORD. Although people who do not have heartburn can have Barrett's Oesophagus, it is found about three to five times more often in people with this condition. Indeed 10-20% of people with chronic GORD will develop Barrett's Oesophagus.

The muscular layers of the oesophagus are normally pinched together at both the upper and lower ends by muscles called sphincters. When a person swallows, the sphincters relax automatically to allow food or drink to pass from the mouth and into the stomach. The muscles then close rapidly to prevent the swallowed food or drink from leaking out of the stomach back into the oesophagus or into the mouth. These muscles make it possible to swallow while lying down or even upside-down. When people belch to release swallowed air or gas from carbonated beverages, the sphincters relax and small amounts of food or drink may come back up briefly; this condition is called reflux. The oesophagus quickly squeezes the material back into the stomach, and this is considered normal.

When a person experiences this regularly, especially when not trying to belch, then it is considered a medical problem or disease. The stomach produces acid and enzymes and when this mixture refluxes into the oesophagus frequently, it may produce symptoms. These symptoms, often called acid reflux, are usually described by people as heartburn, indigestion or "gas". The symptoms usually consist of a burning sensation below and behind part of the breastbone or sternum. Most people have experienced these symptoms at least once, typically as a result of overeating. Other situations that provoke GORD symptoms include obesity, eating certain types of food and pregnancy. In most people, GORD symptoms may last only a short time and require no treatment. However, the more persistent and numerous these symptoms become, it is recommended that the person consult their doctor. These symptoms, if continuing for some time without relief from 'over-the-counter' ant-acid agents, can contribute to the development of GORD and eventually Barrett's Oesophagus.

The average age of patients diagnosed with Barrett's Oesophagus is 60; diagnosis of this condition diminishes the younger the person is, as Barrett's develops over a longer time than GORD. Indeed it is uncommon for Barrett's to be diagnosed in children. It is about twice as common in men as in women, and much more common in white men than in men of other racial background.

Treatment

Barrett's Oesophagus has no simple cure, besides surgical removal, which is only performed if the patient has a very high risk of developing Oesophageal Cancer. Treating the associated acid reflux is important. Most physicians recommend treating GORD with acid-blocking drugs, since this is sometimes associated with an improvement in the extent of the Barrett's tissue. While this is also practiced at the Centre for Digestive Diseases, patients who present with Barrett's Oesophagus may at times undergo treatment with Argon Plasma Coagulation “which burns away” the Barrett’s tissue. This procedure allows the Gastroenterologist to remove tissue while performing a panendoscopy. It involves using argon gas and electrical current to result in the very shallow burn of the abnormal tissue without any direct contact. As a result Barrett's Oesophagus can be successfully treated if it is only very short. An upcoming effective method to remove Barrett’s tissue and, therefore, reduce the chance of getting oesophageal cancer, is to freeze the Barrett’s tissue off and it becomes replaced with normal oesophageal lining provided the patient remains on acid suppressing medications such as Losec, Somac, Pariet or Zoton.

 


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