Barrett's Oesophagus

Barrett's oesophagus is a problem with the lining of the oesophagus in which the lining is inflamed and damaged by stomach acidity traveling up into the oesophagus. Food passes through the oesophagus or "food pipe" and enters the stomach. Under normal circumstances, the food enters the stomach and stays there. In some cases, the sphincter that keeps the food in the stomach is weak and food backs up into the oesophagus. Acid backs up, too, and this damages the oesophageal lining. This is known as gastroesophageal reflux disease or just reflux.

Most of the time when you have reflux, you get heartburn. Heartburn is a sign of damage and inflammation of the oesophagus. If this persists for several months or years, you can get cellular changes in the oesophagus that are called Barrett's oesophagus.

Risk factors for Barrett's oesophagus include being male, who have a higher incidence of the disease, drinking alcohol, and having gastroesophageal reflux disease for many years. Developing Barrett's oesophagus means that you can develop dysplastic changes or "dysplasia" of the oesophagus, which means that you are developing precancerous changes of the oesophagus. This means cancer of the oesophagus is possible.

Symptoms of Barrett's oesophagus are few. You can have it for many years and not know it at all. You can also have symptoms of acid reflux including indigestion and heartburn. Most patients with Barrett's oesophagus have no symptoms at all.

If you have gastroesophageal reflux disease or GERD for a long time or have severe symptoms, you can have your doctor perform an upper GI endoscopy. This involves using a thin tube that has a camera on the end of it. It is inserted into the oesophagus through your mouth and the doctor can visualize any inflammation of the oesophagus that might be there. Biopsies can be performed through the endoscope that will show changes associated with Barrett's oesophagus or may show changes consistent with a precancerous or cancerous state. Often, endoscopies are done on a regular basis looking for positive or negative changes in the oesophageal lining.

There is treatment for Barrett's oesophagus that begins with managing GERD symptoms. This keeps the Barrett's oesophagus from getting worse. These changes include dietary changes. You must avoid caffeine, peppermint, chocolate and fat in your diet. These decrease the pressure in the lower oesophageal area. They allow the stomach acid to flow in the reverse direction. You should also avoid tobacco and alcohol, and you should never lie down directly after eating a large amount of food. If you are overweight, you should lose weight and you should try to sleep with the head of the bed above the level of the base of the bed. This can be accomplished by putting boards or bricks beneath the bed frame on the head of the bed. If you take medication, drink them with plenty of fluids.

There are many medications that can reduce stomach acid and relieve GERD symptoms. These include H2 blockers like Tagamet and Axid. They also include proton pump inhibitors like Prilosec. Take antacids after meals and before you go to bed. There are pro-motility drugs that will propel the food through the stomach faster and will prevent backup of food into the oesophagus.

You can have anti-reflux surgery in the form of a laparoscopic Nissen fundoplication. This can create a new sphincter for the oesophagus at the gastroesophageal level. If you have dysplasia, the precancerous tissue can be treated with a treatment called photodynamic therapy. This involves a laser device and the use of a medication called Photofrin which sensitizes the tissue. You can use other forms of energy to destroy the dysplastic tissue and prevent cancer. Surgery can also be done to directly remove the dangerous tissue from the oesophagus.