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WHAT IS BARRETT’S OESOPHAGUS?

Barrett’s oesophagus is a pre-cancerous disease that affects the lining of the oesophagus.

BARRETT’S OESOPHAGUS

Barrett’s oesophagus is a pre-cancerous disease that affects the lining of the oesophagus. It occurs when stomach acids and enzymes leak back into the oesophagus. Over time, the chronic injury from the acid backwash cause the oesophagus cells to change. It is common for a patient with untreated gastro-oesophageal reflux disease (GORD) to develop Barrett’s oesophagus.1 Estimates suggest that over 95% of Barrett’s oesophagus patients also have GORD.2

Barrett’s oesophagus is the primary risk factor for oesophageal cancer and can increase a person’s risk by 50 times or more.3-6

Barretts oesophageal Cancer Infrographic 82% die within five years of diagnosis

BARRETT’S OESOPHAGUS SYMPTOMS

People with Barrett’s oesophagus may not experience any symptoms.7 However, chronic heartburn, difficulty swallowing, nausea, chest pain, and other symptoms of GORD may indicate a need for further testing.

In addition to suffering from chronic heartburn, other factors that may put a person at risk for Barrett’s oesophagus include:8

  • Obesity
  • Caucasian ethnicity
  • Family history
  • Male gender

To know for sure if you have Barrett’s oesophagus, consult a gastroenterologist (GI). Barrett’s oesophagus cannot be diagnosed by symptoms alone. Diagnosing Barrett’s is dependent on an upper endoscopy.

Sitting in kitchen, man coughs while next to his wife.

DISEASE PROGRESSION AND COMPLICATIONS

Barrett’s oesophagus can progress to more serious stages, potentially resulting in oesophageal adenocarcinoma, a type of oesophageal cancer.4,5,9

 

There are three stages of Barrett’s oesophagus, which range from intestinal metaplasia without dysplasia to high-grade dysplasia. Dysplasia signifies the presence of abnormal cell growth within bodily tissue. The presence of dysplasia is not considered cancer but may increase the risk of developing cancer, so medical guidelines recommend treatment.10,11

 

  • Intestinal Metaplasia Without Dysplasia: Barrett’s oesophagus is present, but no pre-cancerous changes are visible in the cells of your oesophageal lining.
  • Low-Grade Dysplasia: Cells show early signs of pre-cancerous changes that could lead to oesophageal cancer.
  • High-Grade Dysplasia: Oesophagus cells display a high degree of pre-cancerous changes, thought to be the final step before oesophageal cancer.

 

STAGES OF BARRETT’S OESOPHAGUS

Normal, healthy esophagus

Normal, healthy oesophagus  

 

Esophagus affected by low-grade dysplasia (LGD)

Low-grade dysplasia
 

Esophagus damaged by erosive esophagitis (EE), prolonged acid exposure

Oesophagus damaged by prolonged acid exposure

Esophagus affected by high-grade dysplasia (HGD)

High-grade dysplasia
 

Esophagus progressed to nonplastic Barrett's esophagus (NBDE)

Non-dysplastic Barrett’s oesophagus

 

Oesophagus suffering esophageal adenocarcinoma

Oesophageal adenocarcinoma
 

OESOPHAGEAL ADENOCARCINOMA

Cancer occurs when the abnormal cells involved in Barrett’s oesophagus engage in rapid and uncontrolled growth and invade the deeper layers of your oesophagus. This type of oesophageal cancer is called oesophageal adenocarcinoma (EAC) and it can spread beyond the oesophagus.

Although still considered rare, EAC is the most rapidly rising cancer in the U.S.12,13 Between 1975 and 2001, the incidence of oesophageal adenocarcinoma rose approximately six-fold.9 In addition, mortality increased more than seven-fold.14 Patients with Barrett’s oesophagus are 30 to 125 times more at risk of developing EAC than patients without the condition.15 Only 18% of patients survive at least five years after the diagnosis of oesophageal cancer.13

The good news is that there is treatment available. Radiofrequency ablation has been shown to eradicate Barrett’s oesophagus and significantly reduce the risk of progression to high-grade dysplasia and esophageal adenocarcinoma.7,16,17

 

1

Dymedex Market Development Consulting, Strategic Market Assessment, Barrx, October 30, 2014. References 1, 3-5, 7-13, 15, 16, 20-23, 25, 27-29, 40-44, 46, 48-50, 54-59, 62-66, 68-75, 78, 79, 81, 82, 87-89, and 97 from the full citation list, access at http://www.medtronic.com/giclaims

2

Spechler SJ. Barrett’s esophagus. N Engl J Med. 2002;346(11):836-42.

3

SEER Cancer Statistics Factsheets: Esophageal Cancer. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/esoph.html.

4

De Jonge PJ, van Blankenstein M, Looman CW, Casparie MK, Meijer GA, Kuipers EJ. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut. 2010;59:1030-6.

5

Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375-83.

6

Wani S, Falk G, Hall M, Gaddam S, Wang A, Gupta N, et al. Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2011;9(3):220-7.

7

Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373(9666):850-61.

8

Spechler SJ, Souza RF. Barrett’s esophagus. NEJM. 2014;371:836-45.

9

Pohl H, Welch HG. The role of over diagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142-6.

10

Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. The American Journal Of Gastroenterology. 2016;111(1):30-50. doi:10.1038/ajg.2015.322.

11

Wani S, Qumseya B, Sultan S, et al. Endoscopic eradication therapy for patients with Barrett’s esophagus-associated dysplasia and intramucosal cancer. Gastrointestinal Endoscopy. 2018;87(4):907-931.

12

Reid BJ, Weinstein WM. Barrett’s esophagus and adenocarcinoma. Gastroenterology Clinics of North America. 1987;38:477-92.

13

"What Are the Key Statistics about Cancer of the Esophagus?" Cancer.org. 2006. American Cancer Society. Accessed October 2007.

14

Gilbert EW, Luna RA, Harrison VL, Hunter JG. Barrett’s esophagus: a review of the literature. J Gastrointest Surg. 2011;15:708-18.

15

Eisen GM. Ablation therapy for Barrett's esophagus. Gastrointestinal Endosc. 2003;58:760-9.

16

Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12)1209-17. doi:10.1001/jama.2014.2511.

17

Wolf WA, Pasricha S, Cotton C, Li N, Triadafilopoulos G, Raman Muthusamy V, et al.  Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus. Gastroenterology. 2015;149(7):1752-1761.