SPECIALISTS IN THIS AREA
Should someone with Barrett's Oesophagus have an endoscopy?
What are my options if my endoscopy comes back positive for something?
If someone has Barrett's Oesophagus, how often is an endoscopy recommended?
Dr. Lovat explains the progression of GORD to BE
Dr. Lovat- Why is it worth travelling for treatment?
Dr. Lovat- Progression of BE to cancer
Dr. Lovat talks about the symptoms of GORD and BE
Dr. Lovat discusses the importance of treating BE patients
Dr.Lovat's patient care management
Dr. Lovat discusses using the HALO360 and HALO90 ablation catheters
Dr. Lovat- using the HALO90 ablation catheter
Dr. Lovat- Ensuring efficacy when treating with RFA
Barrett’s oesophagus or Barrett’s mucosa is a condition which occurs in approximately 10% of patients who suffer with long-term acid reflux.
It is thought to be a protective mechanism against the pain of the reflux. It is not clear why some people develop it and many others do not.
Does it matter? Not really, except that it is confusing. This condition would be just a medical curiosity except that it causes cancer in a small number of sufferers. That is why people get worried about it. For most people, however, it causes no problems at all.
What is Barrett’s Oesophagus?
Normally, the oesophagus (or gullet) is lined by layers of short, squat cells, called squamous cells. This multi-layered lining is similar to the skin. It protects the oesophagus from injury when swallowing food. It has a very pale pink colour.
‘Reflux’ occurs when juices from the stomach and small bowel flow back up into the gullet repeatedly, over an extended period. This exposure to acid and bile can injure its lining. This injury is called oesophagitis.
In some cases, when the gullet heals, the normal squamous lining is replaced by cells that resemble the stomach or intestine; a process called metaplasia or change in cell shape. It is this abnormal lining, which has a much deeper salmon red colour, that is called Barrett’s Oesophagus.
The most important message is that even if you have Barrett’s disease, the likelihood you will ever get cancer is very low. Indeed, the lifetime cancer risk for people with this condition is no more than 5-10%. The vast majority of people die of something else.
Who get’s Barrett’s Oesophagus?
One in 10 people in the UK with a history of heartburn are estimated to have this condition. This means that about half a million people are affected in the United Kingdom, although most people are simply not aware of it.
(It turns out that the more aggressive the reflux is, the higher the likelihood of developing Barrett’s esophagus.
What is dysplasia?
In a small number of people, further changes occur in the cells within the gullet lining. This change is called dysplasia. Dysplasia is the first step towards the development of cancer.
Dysplasia can be detected by examining biopsies (small samples of tissue) taken from the inner lining of the oesophagus under the microscope. These samples are collected during endoscopy check ups. It can occur many years before cancer develops. That is why many people with Barrett’s disease have these regular check-ups.
What type of cancer develops?
There are two types of oesophageal cancer. One is called squamous cell cancer. The other is called adenocarcinoma. Patients with Barrett’s disease develop adenocarcinoma. It is also sometimes referred to as ‘heartburn cancer’. The charity heartburn Cancer Awareness and Support supports people with this type of cancer.
Barrett’s Oesophagus Symptoms
The symptoms are actually those of acid reflux rather than the Barrett’s. Typical symptoms include:
- Chest pain
- Regurgitating food or acid into the mouth
- Difficulty swallowing
- Hoarse voice
The real causes of symptoms in Barrett’s oesophagus
The symptoms people suffer are usually due to one of three things:
- acid reflux which is not completely treated
- a newly developing cancer or pre-cancerous abnormality
- an unrelated cause which might need to be investigated
If you have symptoms, what should you do?
There is no doubt that if you know that you have Barrett’s oesophagus or Barrett’s Mucosa and have on-going symptoms, you should consult your doctor.
- The doctor may try to improve your acid suppression medicine
- Your doctor may also refer you to a specialist for an endoscopy. Endoscopy is currently the only test that can reliably detect if a pre-cancerous abnormality or early cancer is developing.
- Remember that pre-cancerous changes and early cancers can now be effectively treated without having major surgery. For more information click here
- There are many unrelated conditions which can mimic reflux. Honestly, there is no point writing the list here. If you are worried, go and see a good doctor!
I went to my GP but I still have symptoms. What should I do?
If you have on-going symptoms, here are some things you might try:
Change your diet
- Don’t eat for at least 2 hours before going to bed
- Avoid triggering foods such as fatty meals and coffee
Try a simple antacid
- These medicines neutralize stomach acid. They will give short term relief only but if you are in pain, they can be effective instantaneously
Alginates contain an antacid but also have the extra benefit of the alginate coat which protects the lining of the oesophagus from the acid or bile which is coming up from the stomach.
Take your proton pump inhibitor twice daily
- Taking this medicine twice daily is much more effective than taking it only once a day
- You will get the maximum benefit if you take it 30-60 minutes before breakfast and supper
- For example, taking 20mg of omeprazole twice a day before breakfast and supper is far better than taking 20mg or even 40mg just before going to bed
Try a herbal remedy
- Old wives’ tales sometimes carry an element of truth. Although people with Barrett’s tend to have bad reflux, they sometimes get significant and unexpected relief by trying simple remedies
See a specialist
- If your symptoms are new or not responding to medicines quickly, it is important to have a specialist review. Sometimes, a change in symptoms is a warning sign of something more serious.
Cancer Risk In Barrett’s Oesophagus or Barrett’s Mucosa
You are reading this page because you want to know the esophageal cancer risk in people with Barrett’s oesophagus (BE).
Most websites do not actually state the risk. They just tell you that the BE is pre-cancerous. Large numbers of people who have this condition believe it is just a matter of time until they will get oesophageal cancer, particularly the type called esophageal adenocarcinoma. Nothing could be further from the truth!
Let me reassure you. You know that there are only two things for certain in life – death and taxes. You will, of course, die one day (hopefully in a very long time from now!). But, even if you have Barrett’s oesophagus, it is very unlikely that you will die from cancer of the oesophagus. In fact, despite having Barrett’s oesophagus it is at least 10-20 times as likely you will eventually die from something other than oesophageal cancer!
The real risk of Oesophageal Cancer in Barrett’s Oesophagus
Over the last few years, large numbers of scientific studies have focused on assessing the cancer risk associated with BE. Since 2010, three big studies have shown that the likelihood of getting oesophageal cancer is no more than 0.36% per year. This means that the average person with Barrett’s would need to live for 300 years before they got cancer!
Reducing the Risk
The risk of getting cancer if you have BE is very low, but it is still quite a bit higher than the general population. Does anything reduce that risk? Is there anything one can do to minimise the risk?
There is increasing evidence that a diet high in fruit and vegetables protects against many illnesses including cancer. This holds true for oesophageal cancer. Heavy food including red meat might increase cancer risk although this is by no means certain. It seems sensible to limit the amount of red meat in your diet, perhaps to no more than once or twice a week.
Although you might intuitively think that foods which increase acid reflux , and by extension, more severe acid reflux, increase the risk of cancer, there is actually very little evidence to support this! In fact, many people who do eventually get oesophageal cancer have never even suffered with heartburn.
Aspirin and NSAIDs
Non steroidalanti inflammatory drugs (NSAIDs) such as Nurofen, diclofenac etc might decrease the risk of getting cancer. There is no evidence that paracetamol decreases this risk.
(Please remember that these medicines also have side effects. You should only take medicines after discussing the risks and benefits with a doctor. If you are thinking of taking these medicines, please either see your GP or one of our experts.
Many people think that aspirin might reduce cancer risk. It is not proven, although the large AspECT trial is on-going to find out whether this is true. See below for more details.
A very large group of people with Barrett’s esophagus has been followed for many years in the USA. An interesting finding in this group is that those who used multivitamins every day appear to have a 60% lower risk of developing cancer.
This needs to be confirmed by other researchers because other studies have suggested that vitamin supplements are not entirely free of risk!
There is a very large study going on in the UK called the AspECT trial. It is comparing the use of acid suppression medicine (esomeprazole) and aspirin to see if either of these medicines reduce the oesophogial cancer risk in BE sufferers. Over 2,500 people are taking part in this study. The results will not be known until around 2020.
So how do I reduce my own cancer risk?
If you want to reduce your cancer risk, you should eat a sensible diet, high in fruit and vegetables.
It is not clear whether you should avoid reflux causing foods although it seems to be a good idea.
How about keeping an eye on the problem by reviewing your situation with a specialist? That way you can keep up to date with the latest research and medical knowledge. We offer endoscopic surveillance together with advanced endoscopic imaging.
We can also advise you on some of the genetic risks, call us for a private consultation on 020 7183 7965.
Please tell our staff that you want to see an international expert in cancer risk in Barrett’s oesophagus. We will ensure you see the right person.
Barrett’s Oesophagus Treatments
Ablation of Barrett’s oesophagus
The Halo radio-frequency device was developed to remove the abnormal inner lining (mucosa) of Barrett’s oesophagus whilst leaving the deeper muscular wall of the oesophagus intact. It appears to be effective and safe. The treatment is done during a standard endoscopy, which can be performed under sedation, and takes approximately 30 minutes. It is done as a day case and the patient does not need to remain in hospital. Most patients suffer chest discomfort and difficulty swallowing for a week or two. Occasionally patients complain of nausea for a few days as well but no other symptoms. Very occasionally, patients need to be readmitted to hospital for a couple of days in the week after treatment due to difficulties swallowing.
Ablation of dysplasia in Barrett’s oesophagus
Approximately 2% of patients develop this precancerous change every year and once high grade dysplasia develops, the risk of cancer in the next 5 years is around 50%. Eradication of high-grade dysplasia definitely prevents these patients from getting cancer. Most patients require between two or three treatments and a small number need more than this. About one in 12 patients develop a stricture (narrowing) of the oesophagus after treatment but this resolves after the oesophagus is dilated (stretched) at a further endoscopy.
Studies show that eradication rates for low grade and high grade dysplasia using HALO radiofrequency ablation are between 80-90%. We now have data for more than five years of follow up. Ten year data will be available in the next few years. We are confident already that there will be long-term benefits by using radiofrequency ablation compared to alternative methods. NICE has approved this treatment for this indication and the British Society of Gastroenterology has also endorsed it. It is now considered to be first line therapy for patients with dysplasia in Barrett’s oesophagus.
Patients with high grade dysplasia need counselling regarding other established treatment options including surgery and photodynamic therapy. For some people, it may be more appropriate not to undergo any treatment at all, particularly if they are elderly and have other illnesses. Patients should be certain that Halo radiofrequency ablation is the appropriate treatment for them before embarking on it. In particular, there is published information from NICE regarding photodynamic therapy and patients should read this before proceeding with any type of therapy for high grade dysplasia.
Ablation of low-grade dysplasia or non-dysplastic Barrett’s oesophagus.
Treating Barrett’s Oesophagus
People get confused about Barrett’s oesophagus treatment including ablation therapy. But actually it is simple (when you know how)!
Ask yourself these two simple questions:?
- Do I have any symptoms? What are they?
- How do I make sure I don’t get cancer?
Barrett’s oesophagus causes no symptoms at all. That’s right. Most people with the condition simply don’t know they have it. They only discover that they do have Barrett’s if they have an endoscopy test.
So why do people have an endoscopy test? Because they have symptoms!
But if they have an endoscopy, Barrett’s oesophagus must be causing the symptoms – right? WRONG!
Actually, Barrett’s oesophagus is the body’s response to bad acid reflux. It is the acid reflux that causes the symptoms.
If you are suffering with heartburn, regurgitation of food or a bitter taste in your mouth, you are almost certainly suffering with acid reflux symptoms. Other symptoms may be due to reflux but might be due to something completely different.
Only one in ten people with acid reflux develop Barrett’s oesophagus, but everyone with Barrett’s has reflux.
If you have Barrett’s syndrome, you need treatment. The treatment is almost certainly going to be for acid reflux.
For more information on the different approaches to treating acid reflux click here
If you have difficulty swallowing or pain on swallowing, you probably need to have an endoscopy test. These symptoms can also be due to acid reflux, but we know that a small number of people with Barrett’s can get cancer. These symptoms can also be a sign of cancer. If you have these symptoms, you should see your doctor and discuss whether you need an endoscopy.
If you would like to make an appointment with one of our specialists for help with your symptoms, please click here.
Treatment to Prevent Cancer
Remember that 95% of people, that is 95 out of every 100 people with Barrett’s oesophagus will not get oesophageal cancer ever.
The trick is to work out who is at high risk of developing cancer. We offer this service, by performing surveillance endoscopy and doing routine and specialist histological tests on the biopsy samples we take.
If you have a significant chance of developing cancer, the doctor will know when they get results of biopsy tests from the endoscopy. At that point, they should be prepared to intervene.
At the London Gastroenterology Centre, our world-class specialists offer the full range of treatments. We will recommend the treatment(s) most appropriate for you.
- Endoscopic mucosal resection
- HALO radiofrequency ablation for dysplastic Barrett’e oesophagus and for non-dysplastic Barrett’s
- Surgical oesophagectomy
We have also done research in other treatment types including
- Photodynamic therapy
- Argon plasma coagulation
You can also learn about technical aspects of HALO radiofrequency ablation
Please click on the links at the bottom of this page to find out more about treatments for Barrett’s oesophagus to prevent cancer.
For more information on Barrett’s oesophagus, please use the menu below to navigate through our pages
We recommend that treatment for Barrett’s oesophagus should be undertaken by experts. We offer this service. Make an appointment with one of our specialists who will be able to advise you. Please tell our office staff that you want to see an expert in Barrett’s oesophagus. We will ensure you see the right person.
There are quite a few ways you can help yourself if you have Barrett’s disease. These include:
- Reducing your acid reflux
- Support groups
- Raising awareness
Reducing your acid reflux
There is no proven link between the severity of acid reflux and the risk of developing cancer. Nonetheless, it would seem sensible to try and reduce the amount of reflux you suffer. At the very least, it will help you feel better!
Most people with Barrett’s oesophagus have rather bad reflux and need to take proton pump inhibitor medicines regularly. Twice daily works better than once daily and taking them half an hour before meals works best of all.
If you get breakthrough symptoms at night, a dose of a H2 receptor antagonist (eg Ranitidine) before you go to bed may help you.
A number of diets are available for you to think about.
- Firstly, consider a diet which reduces your acid reflux.
- Secondly, a diet which is high in fruits and vegetables reduces cancer risk (see here as an example fruits and vegetables reduces cancer .) If you search the web, you will realize that the same diets also reduce heart disease and stroke risk!
- Reduce the amount of alcohol you drink. Alcohol is implicated in both acid reflux and oesophageal cancer
There are a number of charities around the UK which are run by sufferers for sufferers. Here are links to a few of them
- Heartburn Cancer Awareness and Support (H-CAS). This charity has an on-line patient forum.
- Barrett’s Oesophagus Campaign (BOC) This charity has an on-line patient forum.
- Fighting Oesophageal Reflux Together (FORT)
Many sufferers are concerned that their GP or pharmacist knows very little about Barrett’s oesophagus. It is the fourth commonest cause of cancer death in men in the UK but so few people seem to be aware of it.
If you would like to get involved, here are some resources you might find useful. Why not contact one of the patient charities and offer to help publicise Barrett’s oesophagus in your local area? Or you could start up your own local or on-line support group.