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What is Barrett’s oesophagus?

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What is Barrett’s oesophagus?

The oesophagus is a muscular tube that conveys food from the mouth to the stomach.

In healthy adults, the cells that line the oesophagus are flat (squamous) and coloured pinky-white. In Barrett’s oesophagus, which is also known as Barrett’s epithelium (BE), the cells at the lower end of the oesophagus become columnar in shape (taller and narrower) and to the eye, the area has a redder appearance. This change in cell structure is called metaplasia.

Barrett’s oesophagus is caused by the reflux of acid and bile from the stomach into the oesophagus; the acid causes cellular damage. In approximately 10% of acid reflux cases, BE develops [1]. It is not known why some people develop this condition and why others do not.

Symptoms of Barrett’s Oesophagus

Patients do not experience any symptoms as a result of BE. Many people, however, experience the following because of the underlying acid reflux:

  • Heartburn (indigestion)
  • Swallowing difficulties
  • Nausea
  • Vomiting
  • Hematemesis (blood in vomit)

If you experience any of these symptoms for 2 weeks or longer, or if you ever see blood in your vomit, please seek medical advice.

Barrett’s Oesophagus and Oesophageal Cancer

Barrett’s oesophagus is considered to be a pre-malignant disease. This means it is an indicator of an increased risk of developing cancer. It is NOT a form of cancer itself. Approximately 0.22% (just over 2 cases per 1000 patients who have Barrett’s) develop the most common type of oesophageal cancer: adenocarcinoma [2].

Barrett’s oesophagus is found in about one in 50 people; the exact incidence depends on age and geographical location [3].

Who is at risk?

Barrett’s oesophagus is very uncommon in childhood, but when it does occur it is normally associated with mental retardation [4]. Although the mean age for developing Barrett’s disease is approximately 40 years old, the condition remains undiagnosed in most people until individuals reach their 60s [5].

Barrett’s Oesophagus appears to have a geographical variation with the mean age of diagnosis in England being 61 and 57 in Scotland [6]. It is more common in Caucasians and has a male to female ratio of approximately 2:1 (although one study found this ratio to be as high as 4:1 [6]) [5]. The disease is also more common in individuals of higher socio-economic status, with an odds ratio of 1.58.

There is little evidence to suggest an association between Barrett’s oesophagus and either smoking [5,7] or alcohol [8–10], although evidence for smoking is controversial as smaller studies tend to suggest no association whereas meta-analyses do [11]. One meta-analysis, found a positive association between having ever smoked and Barrett’s oesophagus. Those who had a high pack-year (1 pack year=20 cigarettes per day for 1 year) demonstrated a higher incidence of disease. Interestingly, however, some studies have suggested a lower risk of Barret’s disease in those who consume moderate amounts of wine [9,12].

Although BMI is not a risk factor for Barrett’s disease, central obesity is [13]. However, a higher BMI is associated with a longer segment of Barrett’s oesophagus [14]. Gastro-oesophageal reflux disease (GORD) is shown to be linked to Barrett’s Oesophagus. Approximately 10% of patients with GORD will develop Barrett’s disease. Patients previously infected with Helicobacter pylori has lower risk of Barrett’s disease, which probably has to do with a reduced risk of developing GORD after the infection.

Barrett’s disease is less common in individuals with a higher fibre intake [15]. In fact, one study found that individuals who consumed 35 or more portions or fruit a week benefited from a 40% risk-reduction compared with those who consumed less than 20 portions of fruit per week [16]. Other foods associated with a lower risk of Barrett’s disease include vintamin-C, beta-carotene, omega-3 fatty acids, vitamin E and poly-unsaturated fat [11].

Although most cases of Barrett’s oesophagus do not progress to cancer [17], the following are risk factors for its progression:

  • Age: increased age is associated with an increase in risk of progression.
  • Gender: being male is also a risk factor for the progression of Barrett’s oesophagus to cancer [18]
  • Obesity: there is no clear association between BMI or central obesity and progression of Barrett’s disease to adenocarcinoma. However, an increased insulin resistance is associated with disease progression [18].
  • Smoking: smoking has been shown to be linked to oesophageal adenocarcinoma. Additionally, smokers with Barrett’s are more likely to suffer from disease progression than their non-smoking counterparts [18].
  • Length of Barrett’s oesophagus: a longer Barrett’s oesophageal segment is associated with an increased risk of disease progression [19]

A full discussion of risk factors associated with disease progression can be found in reference [18].

Reference List

  • [1] Fayter D, Corbett M, Heirs M, Fox D, Eastwood A. A systematic review of photodynamic therapy in the treatment of pre-cancerous skin conditions, Barrett’s oesophagus and cancers of the biliary tract, brain, head and neck, lung, oesophagus and skin. Health Technol Assess (Rockv) 2010;14. doi:10.3310/hta14370.
  • [2] Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 2011;365:1375–83. doi:10.1056/NEJMoa1103042.
  • [3] Pophali P, Halland M. Barrett’s oesophagus: diagnosis and management. BMJ 2016;353:i2373. doi:10.1136/bmj.i2373.
  • [4] Snyder JD, Goldman H. Barrett’s esophagus in children and young adults. Frequent association with mental retardation. Dig Dis Sci 1990;35:1185–9.
  • [5] Wong A, Fitzgerald RC. Epidemiologic risk factors for Barrett’s esophagus and associated adenocarcinoma. Clin Gastroenterol Hepatol 2005;3:1–10.
  • [6] Caygill CP, Watson A, Reed PI, Hill MJ, UK National Barrett’s Oesophagus Registry (UKBOR) and the 27 Participating Centres. Characteristics and regional variations of patients with Barrett’s oesophagus in the UK. Eur J Gastroenterol Hepatol 2003;15:1217–22. doi:10.1097/01.meg.0000085490.12407.6b.
  • [7] Kubo A, Levin TR, Block G, Rumore G, Quesenberry CP, Buffler P, et al. Cigarette smoking and the risk of Barrett’s esophagus. Cancer Causes Control 2009;20:303–11. doi:10.1007/s10552-008-9244-4.
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  • [11] Schneider JL, Corley DA, Simard EP, Ward EM, Siegel R, Jemal A, et al. A review of the epidemiology of Barrett’s oesophagus and oesophageal adenocarcinoma. Best Pract Res Clin Gastroenterol 2015;29:29–39. doi:10.1016/j.bpg.2014.11.008.
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  • [14] Abdallah J, Maradey-Romero C, Lewis S, Perzynski A, Fass R. The relationship between length of Barrett’s oesophagus mucosa and body mass index. Aliment Pharmacol Ther 2015;41:137–44. doi:10.1111/apt.12991.
  • [15] Sun L, Zhang Z, Xu J, Xu G, Liu X. Dietary Fiber Intake Reduces Risk for Barrett’s Esophagus and Esophageal Cancer. Crit Rev Food Sci Nutr 2015:0. doi:10.1080/10408398.2015.1067596.
  • [16] Anderson LA, Watson RGP, Murphy SJ, Johnston BT, Comber H, Mc Guigan J, et al. Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol 2007;13:1585–94.
  • [17] Reid BJ, Levine DS, Longton G, Blount PL, Rabinovitch PS. Predictors of progression to cancer in Barrett’s esophagus: Baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol 2000;95:1669–76. doi:10.1016/S0002-9270(00)00988-6.
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