Barrett’s oesophagus is a condition where the lining of the esophagus (food pipe) is damaged and replaced by abnormal tissue that is similar to the lining of the intestine. This change happens due to long-term acid exposure in the esophagus from gastroesophageal reflux disease (GERD). In Barrett’s oesophagus, the normal thin, delicate esophageal lining is replaced with a thicker lining as the cells change to an intestinal type.

Causes and Risk Factors

The main cause of Barrett’s oesophagus is chronic acid reflux, which occurs when stomach acid and digestive juices flow back into the esophagus. This reflux commonly happens after eating large or fatty meals. It may also occur during sleep and when bending over or lying down. Risk factors include obesity, smoking, heavy alcohol use, hiatal hernia and family history. Studies show that White males are more likely to develop Barrett’s oesophagus compared to other groups. The risk increases with age and those diagnosed over 60 years old have the highest risk.

Symptoms

Many people who have Barrett's Esophagus do not have noticeable symptoms. If symptoms do occur they are similar to gastroesophageal reflux disease and may include heartburn, regurgitation of acid, chest pain, pain with swallowing and choking on food. Symptoms are often triggered by certain foods, bending over, lying down or stress. Persistent and recurring symptoms should be evaluated by a doctor.

Diagnosis

If a person experiences frequent reflux symptoms, they may undergo an endoscopy to examine the esophagus. During this procedure, a long, flexible tube with a light and camera is inserted through the mouth to view the lining of the esophagus. Small biopsy samples (samples of tissue) are usually taken from the esophagus to examine under a microscope. This is needed to diagnose Barrett’s oesophagus and rule out other conditions. Tests like an upper gastrointestinal series or barium swallow may also be done.

Global Prevalence and Incidence

Barrett’s oesophagus is most prevalent in Western countries such as the United States, the United Kingdom and Canada. Studies from Europe and North America estimate the prevalence at 1-2% of the general adult population. Rates are higher in males compared to females. The annual incidence is estimated between 0.12% to 0.33% in men and lower in women. However, the prevalence is rising globally as the rate of GERD and its associated risk factors like obesity increase worldwide.

Risk of Esophageal Cancer

Barrett’s oesophagus is considered a serious condition due to the increased risk of developing esophageal cancer over time. It is thought that Barrett’s oesophagus leads to dysplasia (precancerous cells) which can further progress to esophageal adenocarcinoma. The overall risk of cancer in those with Barrett’s oesophagus is low at approximately 0.5% per year but increases with the severity and length of the diseased tissue. New cases of esophageal cancer have risen significantly globally over the past few decades, with adenocarcinoma being the predominant form linked to Barrett’s oesophagus and reflux. Early detection through surveillance programs plays an important role in catching cancer at curable stages.

Surveillance and Management

Individuals diagnosed with Barrett’s oesophagus require periodic surveillance through upper endoscopy to monitor for dysplasia and cancer. Biopsies are taken and the surveillance interval depends on findings and cancer risk level. Lifestyle changes are advised like weight loss, avoiding alcohol and tobacco, eating smaller meals and elevating the head of the bed. Medications that reduce stomach acid production and protect the esophagus are commonly prescribed. Radiofrequency ablation can potentially reverse some of the effects and remove Barrett's cells in select cases. If high-grade dysplasia or early cancer are found, surgical options may be discussed.

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