Dysphagia and Stricture

People with Barrett’s frequently reflux more. This includes contents of the bowel as well as the stomach. These contents include bile and pancreatic juices. They are powerful and can destroy almost any food.

The stomach has a strong lining, which is covered with a thick mucus layer. It is relatively unaffected by these juices but it is no wonder they cause problems if they get into the oesophagus!

People with Barrett’s may get very bad reflux, but they get less symptoms than other people. We think the Barrett’s lining somehow protects people from the sensation of reflux. In fact, most people with Barrett’s never even realise they have it.

So when a person with Barrett’s gets symptoms, it is important to think about complications. It is true that these are relatively unusual, but it is worth knowing what to look out for.

Important complications of Barrett’s

• Oesophagitis (inflammation)
• Oesophageal stricture
• Dysplasia (pre-cancerous change)
• Cancer

Remember what Barrett’s Oesophagus is:

Oesophagitis means inflammation of the gullet. Remember that Barrett’s oesophagus is a change in the type of cells lining the gullet. This usually affects the bottom of the gullet only and may vary in length from 1 to 20cm! In most people this change affects a length of less than 5cm. The Barrett’s lining might be inflamed, but is often not inflamed at all.

Oesophagitis

Oesophagitis usually occurs at the top end of the Barrett’s lining. Because the reflux is bad, the sufferer may have really quite severe inflammation. Because the Barrett’s lining protects them from symptoms, they may feel quite normal. So if someone gets new onset or worsening heartburn, it is quite likely that the oesophagitis will be rather severe.

Oesophagitis will usually respond to acid suppression medicines but some people will need more intensive therapy.

Oesophageal stricture

If oesophagitis is not properly treated, the area may start to become scarred. Extensive scarring will cause a stricture or narrowing to develop. This is uncommon now as the proton pump inhibitor drugs have more or less solved this problem for most people.

If a Barrett’s sufferer becomes aware that food is sticking in the chest, however, there is a chance that a stricture has formed.

Increasing acid suppression treatment might help treat the stricture, but in many cases, the narrowed area will need to be stretched by the doctor.

Acid Reflux Attacks

An acid reflux attack can be really unpleasant, particularly if you have never had one before. At its worst, it resembles a heart attack, with severe central chest pain which goes up into the shoulder. If this happens, you need to go to hospital to be checked. If it is less severe, it can still cause bad heartburn, chest pain, or nausea and even vomiting.

Chest Pain

Chest pain due to acid reflux attacks can be almost impossible to distinguish from a heart attack and if it is severe, it needs to be treated very seriously. Nevertheless, there are a few tell-tale signs that the problem is due to digestion.

1. have you just eaten a large or fatty meal? (more likely reflux)
2. are you young and fit? (less likely reflux)
3. can you usually do vigorous exercise? (more likely reflux)
4. have you suffered with indigestion in the past? (more likely reflux)
5. did the pain come on after exercise? (more likely heart)
6. are you also breathless? (more likely heart)

You may need a heart tracing (ECG) or blood tests to be able to distinguish chest pain due to reflux (also called ‘atypical chest pain’) from a heart attack. If you have chest pains which you are worried about, please call your doctor urgently for advice.

Heartburn

This is the most typical symptom of an acid reflux attack. Heartburn is a burning sensation which starts in the pit of the stomach, just below the bottom of the breastbone, and rises through the chest. It is typically brought on by eating, particularly large or fatty meals. It may also be caused by exercise or bending forward.

Waterbrash and Choking

Waterbrash means bringing a bitter or acidic tasting fluid into the back of the mouth. Once again, this particularly happens after eating, exercising or bending forward. If it happens at night, the acidic fluid can go into the lungs. This causes a terrible feeling of choking which can last for a minute or two before subsiding. This choking feeling is never fatal but it is very unpleasant. Fortunately, there are good treatments to prevent this occurring. Indeed, this symptom is the one which tends to respond best to antireflux surgery.

Dysphagia

Dysphagia means difficulty swallowing. There are many causes but if solid foods get stuck somewhere in the throat or chest before reaching the stomach, this can be due to acid reflux. It can, however, be a sign of oesophageal cancer, so you should see a specialist urgently if this occurs.

Cough

An on-going intermittent cough can be due to acid reflux and can actually be the only sign a person has the condition. A reflux related cough responds well to medicines although for some people it can take quite a long time to resolve.

Hoarse Voice

One of the really strange effects of an acid reflux attack is that it can cause the voice to become hoarse.

If the reflux attack occurs in the middle of the night, the person may not even realise it has happened. Instead, they wake up with a hoarse voice which can last for a few days.

If these reflux attacks occur frequently, a person can have a hoarse voice which never gets better. This needs proper investigation and specialised treatment to cure because acid reflux attacks, which present in this way are very difficult to detect.