Patient information leaflet Royal Surrey County Hospital NHS Foundation Trust Barrett s Oesophagus Endoscopy Department
You will only be given this leaflet if you are suspected of having or you have been diagnosed with Barrett s Oesophagus. The information below outlines the condition, the symptoms, the cause and the treatment. What is Barretts Oesophagus? Barrett s oesophagus is a condition which affects the lower oesophagus. It is named after the surgeon who first identified it in the early 1950 s, Norman Barrett. In Barrett s oesophagus, the cells that line the affected area of gullet (oesophagus) become changed. The cells of the inner lining of a normal oesophagus are pinkish-white flat cells (squamous cells). The cells of the inner lining of the area affected by Barrett s oesophagus are tall red cells (columnar cells). The columnar cells are similar to the cells that line the stomach. Understanding the oesophagus and stomach When we eat, food passes down the gullet (oesophagus) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make thick mucus, which protects them from damage caused by the acid. The cells on the inside lining of the oesophagus are different and have little protection from acid. There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down, but normally tightens up and stops food and acid leaking back up (refluxing) into the oesophagus. So, the sphincter acts like a valve. 2
What causes Barrett s oesophagus? The cause in most cases is thought to be due to long-term reflux of acid into the oesophagus from the stomach. The acid irritates the lining of the lower oesophagus and causes inflammation (oesophagitis). With persistent reflux, eventually the lining cells change to columnar cells that line the stomach. It is thought that about 1 in 20 people who have recurring acid reflux eventually develop Barrett s oesophagus. The risk is mainly in people who have had severe acid reflux for many years. However, some people who have had fairly mild symptoms of reflux for years can develop Barrett s oesophagus. Barrett s oesophagus seems to be more common in men than in women. It typically affects people between the ages of 50 and 70 years. Other risk factors for Barrett s oesophagus that have been suggested include smoking and being overweight (particularly if you carry excess weight around your middle). What causes acid reflux? The circular band of muscle at the bottom of the oesophagus (the sphincter) normally prevents acid reflux. Problems occur if the sphincter does not work very well. This is common, but in most cases it is not known why it does not work so well. However, having a hiatus hernia makes you more prone to reflux. A hiatus hernia occurs when part of your stomach protrudes through the lower chest muscle (diaphragm) into the lower chest. Most people have heartburn at some time, perhaps after a large meal. It is people who have severe and long-standing reflux who are more likely to develop Barrett s oesophagus. 3
What does treatment for Barrett s Oesophagus involve and what are the risks? 1. Medications An acid suppressing medication, which prevents your stomach from making excess acid is a common treatment and usually works well. Some people take short courses of this treatment when symptoms flare up. Some people need long-term daily treatment with acid suppressing medications to keep symptoms away. Risks: With any medications, side effects are possible. Please contact your GP if you are uncertain about your medications. 2. Surgery An operation to tighten the sphincter muscle is an option in severe cases which do not respond to medication, or where full-dose medication is needed every day to control symptoms. During this operation the stomach is put back into the correct position and the weakened diaphragm muscle around the lower gullet (oesophagus) is tightened. The operation is usually done these days using a laparoscope (a telescope inserted into the stomach). Risks: the main risks associated with this procedure are difficulty in swallowing, bloating and the return of original symptoms due to inadequate tightening of sphincter. Additional risks associated with major surgery include bleeding and infection. 3. Lifestyle changes? There are various things that you can try to change in your lifestyle that may help to treat your acid reflux. These include losing weight if you are overweight, stopping smoking, if you are a smoker and reducing your alcohol intake if you drink a lot of alcohol. 4
Are there any alternative treatments? The abdominal lining may be destroyed by laser or by heat energy. This is done using an endoscope with the aim of encouraging the normal lining to re-grow. Is Barretts Oesophagus harmful? The changed cells of Barrett s oesophagus are not cancerous. However, these cells have an increased risk, compared with normal gullet (oesophageal) cells, of turning cancerous in time. The changed cells in Barrett s oesophagus can develop something called dysplasia. A cell with dysplasia is an abnormal cell. It is not cancerous, but is more likely than other cells to develop into cancer. It is often called a precancerous cell. There are various degrees of dysplasia from low-grade dysplasia to high-grade dysplasia. Cells that are classed as high-grade dysplasia have a high risk of turning cancerous at some point in the future. What happens after diagnosis? When you have been diagnosed with Barrett s oesophagus, you may be advised to have a gastroscopy and biopsy at regular intervals to monitor the condition. This is called surveillance. When should I seek medical attention? If you develop new symptoms, such as difficulty in swallowing, vomiting blood or weight loss, you should seek urgent medical attention. Reference sources www.patient.co.uk/health/barretts-oesophagus-leaflet www.corecharity.org.uk/assets/files/information_pdfs/ BarrettsOesophagus 5
Further information sources www.patient.co.uk/health/hiatus- hernia-leaflet www.patient.co.uk/health/acid-reflux-and-oesophagitis 6
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Contact details If you require further information or advice, please feel free to contact the Endoscopy Unit between 8-6pm Monday to Friday on (01483) 571122 ext 4160 or out of hours, advice can be obtained from your local Accident and Emergency Department or GP. Royal Surrey County Hospital (RSCH) NHS Foundation Trust fully subscribes to the National Patient Safety Agency (NPSA) Being Open best practice framework, November 2010. PALS and Advocacy contact details Contact details of independent advocacy services can be provided by our Patient Advice and Liaison Service (PALS) who are located on the right hand side as you enter the main reception area. PALS are also your first point of contact for health related issues, questions or concerns surrounding RSCH patient services. Telephone: 01483 402757 Email: rsc-tr.pals@nhs.net Opening hours: 9.00am 3.00pm, Monday to Friday If you would like information documents in large print, on tape or in another language or form please contact PALS. Review date: May 2018 Author: Karen Hill PIN150521 222a Royal Surrey County Hospital NHS Foundation Trust 2015