The Patient Support Network of Barrett's Oesophagus Foundation
About Barretts Oesophagus
Introduction
Norman Rupert Barrett (1903-1979) was born in Adelaide, South Australia and was educated at Eton and Trinity College, Cambridge. He graduated from St. Thomas' Hospital in 1928 becoming a surgeon at St. Thomas' and Brompton Hospitals in London. In 1950, he was among the first to describe the transformation of the oesophageal lining - the condition that bears his name.
What is Barretts oesophagus?
The normal oesophagus (gullet or food pipe) is partly replaced by a pinkish-white tissue called squamous epithelium. (See image below)
Barrett's oesophagus is a condition in which the normal squamous epithelium of the oesophagus has been replaced by an abnormal red columnar epithelium. (See image below)
What causes Barrett's oesophagus?
Many years of reflux (heartburn) are thought to cause Barrett's oesophagus. Up to 10% of patients with reflux develop Barrett's changes in the gullet, particularly:
- Patients who have had severe symptoms for many years
- White men
- Over 50 years old
What causes reflux (heartburn)?
Reflux occurs when the muscular valve at the lower end of the gullet is weak, allowing the backflow of stomach contents. The digestive juices containing acid and bile cause cell damage in the lower gullet lining. These damaged cells can eventually lead to the changes that are called Barrett's oesophagus.
Smoking, alcohol and certain foods such as fats and chocolate and a hiatus hernia can aggravate reflux.
What are the symptoms?
There are no special symptoms of Barrett's oesophagus. Patients who come to medical attention have usually had symptoms of heartburn but may have no symptoms at all. Other symptoms of reflux include:
- Acid regurgitation (sour taste in the back of the throat)
- Food regurgitation (food coming back into the mouth after eating)
- Hoarse voice, chronic cough, painful swallowing or chest pain
A number of patients may develop difficulty with swallowing, sensations of food sticking or symptoms of anaemia (low blood count) and should consult their doctor.
Why is Barrett's oesophagus important?
The majority of patients with Barrett's oesophagus may suffer from heartburn but will have no serious complications. A few can develop problems such as ulcers in the gullet or a narrowing of the gullet called a stricture.
In a very small proportion of patients (currently less than 10%) Barrett's oesophagus can gradually lead to cancer of the gullet or upper stomach.
This may take years to develop and is usually preceded by a further cell change within the Barrett's lining to abnormal appearing cells (dysplasia). Repeating endoscopies and biopsies at regular intervals monitors for these changes. If precancerous changes (dysplasia) are detected early, a cure is usually possible.
Summary of findings from the UK Barrett's oesophagus registry (January 2008)
The UK Barrett's oesophagus registry (UKBOR) created a large comprehensive database that can be used for epidemiological studies. There was baseline information (such as age and sex) on over 10,000 patients and detailed information obtained from analysing the patients' notes from about 2,000 patients. We have summarised the findings from the registry below. Hopefully, this registry could be used as template to build other Barrett's registries in Europe. This may allow pulling data together to get a better understanding of Barrett's oesophagus and why it progressed to cancer.
Barrett's Oesophagus or Columnar Lined Oesophagus
Data analysed by the UKBOR demonstrated an increase in the number of newly diagnosed Barrett's patients under 50 years old. The average age at diagnosis was 62.0 for males and 67.5 for females. There was a slight preponderance of male patients diagnosed with Barrett's (58.8% of males versus 41.2% of females). There was little geographical variation in the age of diagnosis and male to female ratio. It became apparent that high body mass index (an index of obesity) may be a risk factor for young people (below 50 years) to develop Barrett's. Alcohol and tobacco consumption did not appear to be linked to the development of Barrett's.
The total length of the Barrett's segment was shown to be stable both in patients with uncomplicated Barrett's and in patients who progressed to high grade dysplasia and cancer. There did not seem to be any relationship between infection with the bacteria Helicobacter pylori found in the stomach and the grade of dysplasia in the Barrett's.
Cancer (Adenocarcinoma) in Barrett's oesophagus
These analyses were on smaller numbers of patients. In the cohort of Barrett's patients analysed, 4.8% presented to endoscopy with cancer while 0.8% of Barrett's patients developed cancer while in surveillance. The mean age at diagnosis was 64.7 for males and 74 for females. There was a preponderance of male patients diagnosed with adenocarcinoma (66.7% of males versus 33.3% of females).
Smoking was associated with an increased risk of cancer progression in males. Alcohol consumption and high body mass index were not associated with a risk of cancer development. The presence of intestinal metaplasia, one of 4 types of Barrett's that was previously thought to be associated with a higher risk of progression, was not linked to an increased progression compared to the other types. Patients with a segment length of 3 to 6 cm are associated with the lowest risk of progression to cancer and those with a length of more than 6 cm with the highest risk of progression. Patients with a diagnosis of low grade dysplasia had a 1.4% risk per year to develop cancer and this rose to 15.7% if a diagnosis of high grade dysplasia was made.
A preliminary study suggested that patients who underwent an operation (fundoplication) against acid reflux have a lowest risk of development.
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