Gastroesophageal Reflux Disease (GORD), also known as acid reflux, is a common disease in the UK, with the majority of patients presenting with a mild to moderate disease. It is normally treated by your GP.
What are the symptoms?
- Heartburn in the chest, neck or throat
- Acid regurgitation (bringing up acid from your stomach)
- Discomfort or pain in the upper abdomen called dyspepsia
What is the mechanism?
When you swallow, the oesophagus (gullet, food pipe) transports the food from your mouth to your stomach due to effective and coordinated movements. On the border from the oesophagus to the stomach, a ringlike muscle prevents the backflow of food and especially stomach acid from the stomach to the oesophagus.
In some individuals, these mechanisms are less effective, resulting in a backflow of stomach acid in the oesophagus. Unlike the stomach, the oesophagus does not contain a protective layer against the stomach acid. Therefore, if the oesophagus is often exposed to acid it can result in an inflammation called oesophagitis or in rare cases (3 to 6 per cent) a condition called Barrett’s Oesophagus can develop (see below).
What is the treatment?
The goal of the treatment is to reduce the burden of symptoms. The most common medication given is a proton pump inhibitor (PPI) to reduce the amount of acid in your stomach. Lifestyle changes are often also effective such as smoking cessation or reduction of weight. Please consult your GP and discuss further options.
What is Barrett’s Oesophagus?
Barrett’s Oesophagus occurs in 3 to 6 per cent of patients suffering from GORD (see above). In particular, if you suffer from GORD for a long time your chances of Barrett’s increase. The Cytosponge tests specifically for this condition by analysing the collected cells from the oesophagus.
What is the mechanism?
If the cells of the oesophagus are constantly exposed to the acid of the stomach, this can cause a replacement of the original oesophagus cells with abnormal cells. This occurs mostly at the border from the stomach to the oesophagus. Patients with Barrett’s do not have any additional symptoms than those mentioned under GORD.
How can Barrett’s Oesophagus be diagnosed?
Barrett’s can be diagnosed by the Cytosponge test, which you can undergo at your GP practice. After a positive Cytosponge test, patients are referred to the hospital to undergo an endoscopy. Endoscopy consists of a thin tube which has a small camera at the end. This tube enters the oesophagus via your mouth. Through the endoscopy the physician is able 1) to see the extent of changed tissue and 2) to take small tissue samples which are then analyzed to evaluate what kind of abnormal cells can be found.
Why is it important to diagnose Barrett’s Oesophagus?
In rare cases, Barrett’s Oesophagus can develop into oesophageal cancer. This occurs in only 1% of people with Barrett’s Oesophagus in a lifetime. However, oesophageal cancer is a very serious diagnosis which only causes symptoms at a late stage of the disease. Then the disease is often more difficult to treat. Therefore, early detection of oesophageal cancer is crucial. This is achieved by early detection of Barrett’s Oesophagus through the Cytosponge or an endoscopy. Those patients enter a surveillance programme where the oesophagus is monitored with an endoscopy every 2 to 3 years. As soon as cells in the oesophagus show changes that indicate a transition into cancer, treatment can be started.