Overview
Barrett’s oesophagus describes the metaplasia (transformation of one cell type to another) of the lower oesophageal mucosa. The lower oesophageal mucosa is normally lined with stratified squamous epithelium, however, in Barrett’s oesophagus, columnar epithelium with goblet cells is present.
It develops as a consequence of chronic gastro-oesophageal reflux disease (GORD). Chronic inflammation due to stomach acid damages lower oesophageal cells. Cells that are more resistant to inflammation displace normal squamous cells. The degree of GORD and degree of metaplasia do not seem to correlate, therefore, it is difficult to predict who will go on to develop Barrett’s oesophagus.
Barrett’s oesophagus is considered a pre-malignant condition as the normal cells may become dysplastic, leading to oesophageal adenocarcinoma.
Epidemiology
- Barrett’s oesophagus is more common in men
- Prevalence increases with age
Risk Factors
- Acid reflux or GORD
- Increased age
- Caucasian ethnicity
- Male sex
- Obesity
- Smoking
Presentation
Barrett’s oesophagus itself does not tend to have any particular symptoms, however, patients often present with symptoms associated with GORD:
Investigations
- Upper gastrointestinal endoscopy and biopsy:
- Endoscopy may show darker epithelium proximal to the gastro-oesophageal junction
- A biopsy is essential to confirm the diagnosis and degree of metaplasia/dysplasia
Management
- Lifestyle changes:
- Losing weight, reducing alcohol intake, stopping smoking etc.
- Proton-pump inhibitors:
- To manage co-existing GORD
- Endoscopic surveillance:
- Patients with metaplasia and no dysplasia are offered endoscopic surveillance every 3-5 years
- Biopsies are also taken with each endoscopy
- If dysplasia of any degree is present:
- Radiofrequency ablation or endoscopic mucosal resection is offered
Complications
- Dysplasia and oesophageal adenocarcinoma
- Oesophageal structures
Prognosis
- The risk of developing oesophageal adenocarcinoma in Barrett’s oesophagus is up to 60 times that of the general population
- The risk of developing oesophageal adenocarcinoma is higher if dysplasia is present
