Barrett’s Oesophagus

 

Background and Connection with Hiatus Hernia

On the previous page describing what happens with Hiatus Hernia, we mention acid and reflux. Acid burns. That is what acid does. But it is a key element in digestion – which is essential. The stomach is lined with a mucus barrier to prevent the acid digesting the stomach along with its food contents. There are exceptions, for example associated with an ulcer, where the acid does manage to burn the stomach lining. That is both damaging and painful.

When there is reflux of that acidic stomach content, (see Hiatus Hernia) backwards ‘above’ the stomach, namely up into the oesophagus (the pipe that carries the food from mouth to stomach) no such protection exists so the acid starts to burn the oesophagus hhimmediately on contact.

These various burning sensations are colloquially referred to as ‘heartburn’.

Heartburn is unpleasant indeed, but there is a bigger problem lying behind it, which can become seriously dangerous. It all starts with that acid contact with the oesophagus wall. If this acidity (‘heartburn’) is allowed to continue for a long time, there is a danger the burning of the oesophageal wall can bring about a change in the cells making up its substance. This condition is called Barrett’s Oesophagus

So What Is It?

This is a condition in which the lining of the oeosphagus (the food pipe) changes from the usual oesophageal lining (squamous cells) to another (columnar cells) as a result of the damaging effect of the acid.

Symptoms associated with Barrett’s Oesophagus are those that are associated with acid reflux, namely heartburn and food/ fluid regurgitation.

Who can develop Barrett’s Oesophagus?

Patients who have experienced acid reflux for prolonged periods of time, usually secondary to a hiatus hernia, are at risk of being detected with Barrett’s Oesophagus. Not every patient with hiatus hernia, however, is likely to suffer from acid reflux and not every patient with acid reflux is likely to have Barrett’s Oesophagus.

How do I know if I have Barrett’s Oesophagus?

The condition is detected during endoscopy in patients who are undergoing the test for acid reflux or incidentally detected in patients who are undergoing endoscopy for any other reason. On endoscopy Barrett’s is diagnosed by the detection of ‘tongues’ of red stomach lining extending into the pale pink lining of the oesophagus. However, the diagnosis is confirmed on pathological examination by the presence of certain types of characteristic columnar cells.

Why is Barrett’s Oesophagus a concern?

Barrett’s Oesophagus is considered to be a pre-cancerous condition but not everyone with Barrett’s Oesophagus is likely to develop cancer. The shift from Barrett’s cells to cancer cells occurs along a sequence that consists of unstable (dysplasia) cells that are at risk of developing into cancerous cells. (Barrett’s- dysplasia- cancer).

Treatment of Barrett’s Oesophagus

The treatment of Barrett’s Oesophagus is directed at the treatment of acid reflux.

The aim of the treatment, whether it is medications or surgery, is to prevent further acid related damage to the oesophageal lining by the stomach’s acid.

Medications reduce formation of acid by the stomach, thus reducing the extent of the acidity of the fluid that refluxes up into the oesophagus and thus prevent further damage.

Sadly, there is no evidence that medications can reverse Barrett’s back to normal oesophageal lining but there is some evidence that medications can prevent the progression of Barrett’s Oesophagus to cancer.

Surgery aims to repair the hiatus hernia and create a new ‘valve’ that controls the acid from refluxing up into the oesophagus. There is some evidence that surgery can reverse Barrett’s back to the original lining or at least lower the risk of progression to cancer.

How can progression to cancer be detected early?

Regular endoscopy is currently the only way of detecting unstable cells (dysplasia) before they become cancer.

Thus, patients with Barrett’s Oesophagus should be offered regular endoscopy in order to consider more advanced treatments such as radiofrequency ablation (RFA) when Barrett’s progresses to dysplasia.

 

 

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Next: Abdominal wall hernias – Diagnosis and Treatment