The inside of the oesophagus is covered by a robust, multi-layered lining. If stomach juices keep flowing back over the years, the lining at the lower end can transform: it takes on a form otherwise found in the intestine and withstands the acid better. This change is named after the surgeon who described it – Barrett’s oesophagus. It does not cause symptoms itself; it is often discovered during a gastroscopy for heartburn.
The diagnosis is confirmed when two findings come together. During the endoscopy, salmon-coloured lining extends at least one centimetre up into the oesophagus, and the tissue samples show intestine-like cells with what are known as goblet cells. Shorter changes directly at the junction with the stomach do not count as Barrett’s oesophagus and, without other abnormalities, do not need monitoring.
Barrett’s oesophagus increases the risk of a particular form of oesophageal cancer, adenocarcinoma. It is usually preceded by cell changes that specialists call dysplasia or intraepithelial neoplasia and classify as low-grade or high-grade. They cause no symptoms and often only show up in the tissue samples – hence the regular check-ups.
Visible, suspicious areas are removed through the endoscope, for example by mucosal resection. The removed tissue shows how deep a change reaches and therefore whether endoscopic treatment is sufficient. To lower the risk of new lesions in the remaining Barrett’s lining, the guidelines usually provide for it to be ablated afterwards, for example with radiofrequency ablation, a targeted heat treatment through the endoscope. Lining without dysplasia, by contrast, is not treated but monitored.
Mamoon Al Hamed
Mohammad Al Rashdan
Dr. med. Barbara John, FEBGH
