Barretts Oesophagus
What is it?
This is a condition that is very important to know if you have it. It involves a change in the lower oesophagus from a normal lining to a lining that has been damaged by chronic reflux. Barretts is also known as intestinal metaplasia. Barretts is present in approximately 20 - 30 percent of people who take anti reflux medication regularly. This is why it is important to have a gastroscopy test if you take long term medication for reflux. It is even more important to have a gastroscopy before starting long term reflux medication.
Why do we worry about Barretts? Because a certain number of people with this condition will develop cancer in the lower oesophagus which is a life threatening condition. If we know you have Barretts change, then we can monitor the lower oesophagus and intervene before that potentially fatal change develops.
What causes Barretts?
Chronic reflux disease which you may know as heartburn is the primary cause. This can be acid type reflux or bile. There is evidence that it is the bile that may be more of a factor in the initial change. Some people have no classic reflux symptoms and therefore don't know that they may have Barretts. Once you have Barretts change, you can't change that (although there is some argument about this).
What can I do if I have Barretts?
You can have regular screening gastroscopy tests. I recommend yearly. We will take biopsies of the lower end of the oesophagus. If there has been any precancerous or cancerous change then there are options to treat the Barretts with either radio frequency waves or anti reflux surgery. Sometimes there is a need to remove the oesophagus, dependent on discussion with me and your other doctors. Most people will never go on to get cancer in their Barretts segment and it is important to remember that.
Role of anti reflux surgery
There is emerging evidence that anti reflux surgery may prevent progression of Barretts to cancer by physically acting as a barrier to acid and bile. There is also some evidence to suggest if you have low grade change in the Barretts then an operation may reverse this. If you have Barretts then it is likely that you suffer severe reflux symptoms and surgery may help greatly with curing these symptoms and allowing you to stop your medications. Please see the section on Laparoscopic anti reflux surgery.
Role of antacid tablets
These tablets also known as proton pump inhibitors or PPI's have allowed a lot of people to get good relief of their reflux symptoms. They may prevent Barretts disease if taken early on with reflux symptoms. Remember, Barretts is an end stage result of chronic reflux. These tablets also may prevent development of precancerous changes in some people but there is also a school of thought that they may contribute to dysplasia by making the refluxed material less acidic. This is a controversial area and can be further researched by reading the work of Dr Tom Deemester and others at the University of Southern California.