What is the oesophagus?
The oesophagus* is the medical term for the foodpipe or gullet (the word is derived from the ancient Greek word meaning 'passage for food'), which connects the mouth and throat to the stomach. The oesophagus is a 'fibromuscular tube', that is, it contains muscular tissue that helps transport food that has been swallowed to the stomach. It is normally around 25cm in length in adults.
What is Barrett's Oesophagus?
At the stomach end of the oesophagus there is a 'sphincter' - a muscle 'door' - that separates the oesophagus from the stomach and keeps the acidic stomach contents in the stomach, while allowing swallowed food into the stomach. When acidic stomach contents come back up into the oesophagus this causes a slight burning sensation called 'heartburn' which in some cases can cause some regurgitation into the mouth. The whole process is referred to as 'reflux'.
The cells in the stomach lining are very different from the cells lining the oesophagus, and Barrett's Oesophagus describes the condition where some of the cells lining the oesophagus near the sphincter change into cells that look more like cells in the stomach lining.
This happens over time for people who have suffered reflux over a number of years, a condition referred to as GERD (GastroEsophageal Reflux Disease). It is thought that the stomach acids overflowing up into the oesophagus cause this change in the cell structure.
What are the symptoms of Barrett's Oesophagus?
It is not possible to diagnose Barrett's Oesophagus without an internal examination - this could be via...
- An upper endoscopy (LINK) - that is an inspection of the oesophagus and upper section of the stomach using an endoscope, a long tube inserted through the mouth equipped with a light and camera to allow the doctor to examine the oesophagus OR
- An endoscopic biopsy - where a tissue sample is taken from the oesophagus OR
- Ambulatory pH monitoring - this records how much acid is present in the lower oesophagus over a 24 hour period using a thin wire with a detector on the end lowered through the nose and connected to a recording device
Some symptoms which may indicate the possibility of Barrett's Oesophagus, and which are essentially the same as symptoms of GERD and reflux, include...
- Weight loss
- Throwing up
- Swallowing being either painful or difficult
- Continual heartburn
- Feeling full when eating
However Barrett's Oesophagus can also be asymptomatic, that is there are no noticeable symptoms at all.
If Barrett's Oesophagus is diagnosed, it is very important that it is monitored in case the affected cells mutate into pre-cancerous cells, a process called dysplasia, which increases the risk of cancer in the oesophagus.
How is Barrett's Oesophagus treated?
When the condition is diagnosed, it is important to have regular endoscopic examinations (at least every 2 years and in some cases more frequently) to check for dysplasia and/or regular ambulatory monitoring as described above. Reflux and GERD can also be treated with medication to suppress the effects of acid reflux.
In some cases endoscopic surgery may be required to remove cancerous cells or cells that have undergone dysplasia, or surgery may be required to remove the lower section of the oesophagus, where cancer or severe dysplasia are present.
*also referred to as 'esophagus' in American English