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Barrett's Oesophagus

Barrett’s Oesophagus is the replacement of the normal “skin-like” lining of the lower oesophagus by lining that is similar to what is seen in the stomach. This occurs as a consequence of chronic reflux disease, and is initially, probably an attempt to adjust the lower oesophagus to the presence of excess acid. This condition can effectively be silent, in that you may not have been aware that you had reflux disease for as long as you obviously have had it. The significance of tissue in an area that it is not supposed to be, is the possibility that it can become malignant, so in effect, Barrett’s Oesophagus is a potentially pre-malignant condition. It is important that this area of abnormal lining is biopsied at regular intervals to make sure that this process is not progressing. That pre-malignant process is called “dysplasia”. We look for dysplasia on the biopsies that we take. We cannot see dysplasia with the naked eye, so the biopsies are very important. If we see dysplasia on the biopsies we may make your interval to your next endoscopy and biopsies less than 2 years. When Barrett’s is first diagnosed, the interval for endoscopy is usually every 2 years. The abnormal lining or epithelium extends for a variable distance above the end of the gullet and can be shown to increase with time if the disease is not treated .ie. if the acid is not suppressed, this is why we have recommended you take a medication in a class of drugs called proton pump inhibitors. The current medications in this group are Losec, Zoton, or Somac.

The exact statistical risk of developing cancer in the gullet related to Barrett’s Oesophagus is unknown, but in some studies it has been reported to occur eventually in up to 10% of these patients and thus your surveillance biopsies are extremely important. There are now cases in the medical literature of reversal or improvement of the Barrett’s change and thus long term high dose proton pump inhibitor therapy is very important. This is the only established therapy with a hope of a decreased risk for adenocarcinoma of the oesophagus. There are some experimental treatments where the abnormal mucosa is destroyed (by argon plasma coagulation) and the patient is maintained on proton pump inhibitors (or has surgery to fix the reflux) – but these treatments are still in the trial phases.