Being diagnosed with Barrett’s oesophagus can be confusing, and you might wonder how severe your condition is. After all, the treatment we recommend will depend on the severity of your condition. Keep reading to learn about Barrett’s oesophagus stages and treatment options.
What causes Barrett’s oesophagus?
We don’t currently know the exact cause of Barrett’s oesophagus, though it is strongly associated with Gastro-oesophageal reflux disease (GORD). Roughly 1 in 10 patients with GORD go on to get Barrett’s oesophagus. If you have no symptoms, you may have silent reflux, known as Laryngopharyngeal reflux (LPR).
People with Barrett’s oesophagus have a damaged oesophageal lining (lining of the food pipe); linked to damage from stomach acid.
Risk factors for Barrett’s oesophagus
- Frequent acid reflux
- Family History of Barrett’s oesophagus
- Having a hiatal hernia
- Being male
- Caucasian
- Over 50
- Smoking
- Obesity
Read our blog to learn more about Barrett’s oesophagus: Barrett’s oesophagus: What is it?
Barrett’s oesophagus staging
Barrett’s oesophagus has no symptoms, so we often find it during endoscopy for a different issue. Though, we may offer you an endoscopy if you are experiencing signs of GORD. Concerning symptoms include frequent heartburn, a constant sore throat, hoarseness of voice, and food regurgitation. You might also experience swallowing problems.
We take a biopsy during an endoscopy, which allows us to look for cell changes in your oesophageal lining. A biopsy is a small tissue sample.
Before Barrett’s oesophagus, you usually have a healthy oesophagus. Barrett’s oesophagus tissue begins after you’ve experienced frequent acid reflux, which damages the oesophageal tissue.
No dysplasia
Also known as intestinal metaplasia without dysplasia or non-dysplastic, no dysplasia means you have no precancerous cell changes. With Barrett’s oesophagus, the cells in your oesophagus that are normally flat become column-shaped and grow abnormally (dysplasia).
Dysplasia can be low or high grade, depending on how abnormal your cells are. The treatment we recommend will depend on the grade of your dysplasia.
If you have no dysplasia, we usually recommend surveillance, though, in some circumstances, we may make exceptions. For instance, if you have a strong family history of cancer. We may also recommend certain medications, such as proton pump inhibitors (PPIs).
Surveillance means we monitor your Barrett’s oesophagus to see if there is an increase in abnormal cells. We can monitor your oesophagus by performing routine endoscopies to collect biopsies. Our gastroenterologist will inform you of what routine will mean in your case, though it is usually every 2-5 years.
Watch Dr Sarmed Sami, our Consultant Gastroenterologist, explain whether Barrett’s oesophagus can get better by itself.
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We prescribe PPIs to reduce acid production in your stomach. The most common PPIs we prescribe for reflux reduction are omeprazole and lansoprazole.
We can also manage your acid reflux with lifestyle changes. Lifestyle changes include eating smaller meals, sleeping with a raised head, and not eating 4 hours before you sleep or lie down.
Indefinite
An indefinite result means your biopsy showed possible abnormal cells, but the pathologist cannot be certain. This means you don’t have clear evidence of abnormal cells with Barrett’s to consider it dysplasia. The abnormal cells may be reacting to frequent irritation from acid reflux or heartburn.
If we discover indefinite Barrett’s, we might arrange a follow-up endoscopy in 3-6 months to monitor your condition. We will also recommend lifestyle changes and possibly medications to reduce your acid reflux to see how this affects your abnormal cells.
Low-grade dysplasia
Low-grade dysplasia means we have found evidence of a small amount of dysplasia. We may decide to do further tests to assess your condition, such as endoscopic ultrasound or another endoscopy.
We consider abnormal cells with Barrett’s as precancerous, but, unlike cancer cells, they cannot spread. To treat low-grade dysplasia, we might perform endoscopic therapies such as HALO radiofrequency ablation (RFA). We also need to make sure that acid reflux is well controlled. In rare cases, we may recommend surgical procedures to achieve that. Surgeries commonly performed to counter the symptoms of GORD include a Nissen fundoplication, LINX, Transoral Incisionless fundoplication (TIF) and Stretta anti-reflux procedure.
Fundoplication
Fundoplication strengthens the valve at the end of your oesophagus to prevent acid reflux, reducing indigestion and heartburn. This valve is the lower oesophageal sphincter (LOS).
Learn more about Fundoplication for Barrett’s in our blog: Barrett’s oesophagus surgery: Is it necessary?
LINX
LINX reflux surgery involves placing a flexible band of magnetic beads around the end of your oesophagus. The beads mimic the LOS and again prevent acid reflux.
Stretta therapy
We use stretta therapy to thicken and strengthen the LOS with radiofrequency energy or heat. Stretta therapy can reduce or eliminate the reliance on reflux-reducing medications, such as PPIs.
High-grade dysplasia
High-grade dysplasia is an advanced precancer. If you have high-grade dysplasia, it means we have found very abnormal cells in the Barrett’s oesophagus area. These cells indicate a high risk for developing oesophageal cancer, though they cannot spread as cancer cells can.
People with high-grade dysplasia often need a repeat endoscopy with biopsies to confirm that there are no cancer cells present. For these people, we recommend either minimally invasive procedures, such as various endoscopic therapies or invasive procedures.
Though, we usually reserve invasive procedures, such as oesophagectomy, for people with signs of early oesophageal cancer.
Endoscopic therapies:
- Endoscopic Resection (ER)
- HALO radiofrequency ablation (RFA)
- Cryoablation
- Argon plasma coagulation
Oesophagectomy
An oesophagectomy is a surgical procedure in which we remove the affected part of the oesophagus. We then restructure the oesophagus with a part of your stomach or large intestine.
If we catch oesophageal cancer quite early, we may be able to remove the cancer with ER and HALO RFA. We prefer to use an endoscopic therapy as they have a lower risk of complications.
Book an appointment
If you need testing for Barrett’s oesophagus or require staging tests, Digestive Health UK can help. Our expert gastroenterologists specialise in endoscopic procedures, which we can use to test for and treat Barrett’s oesophagus.
Once we have confirmed the stage of your Barrett’s, we will recommend and perform the most suitable treatment option. We will talk you through all the steps, benefits and risks of each treatment and will answer any questions you have. We want you to feel confident knowing you have picked the right treatment and gastroenterologist for you.
Book an appointment today to begin your treatment process.
