BARRETT’S ESOPHAGUS
Barrett’s esophagus is a condition that occurs when cells in the lining of the esophagus are damaged, usually because of exposure to acid from the stomach. The abnormal cells caused by Barrett’s esophagus can become cancerous in some cases, though this is rare.
Q. What is Barrett's esophagus?
Barrett's esophagus results from an irritation in the lining of the esophagus (food tube) caused by chronic reflux (flowing backward) of the contents from the stomach and small intestine into the esophagus. The irritation causes the lining of the esophagus to change and become similar to the intestine and stomach lining.
Q. What are the symptoms of Barrett's esophagus?
Barrett's esophagus does not cause any distinct signs or symptoms. Still, there is a strong link between gastroesophageal reflux disease (GERD) and Barrett's esophagus. The symptoms of Barrett's esophagus may be similar to those of GERD. These symptoms might include:
A burning sensation under the chest
Regurgitation (backing up) of stomach acids
Difficulty swallowing (Note: This symptom requires immediate medical attention.)
Q. What is the cause of Barrett’s esophagus?
The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. However, some people diagnosed with Barrett's esophagus have never experienced heartburn or acid reflux.
Q. What risk factors are associated with Barrett's esophagus?
There are many risk factors for the development of Barrett's esophagus, including:
Chronic heartburn and acid reflux
Obesity
Increasing age
Caucasian ethnicity
Male gender
Smoking
Family history of Barrett's esophagus
Q. What complications are associated with Barrett's esophagus?
Barrett's esophagus is a premalignant (precancerous) condition that may lead to the development of cancer of the esophagus in a small number of patients. The risk of developing cancer is approximately 0.5% each year. This type of cancer is called esophageal adenocarcinoma.
Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia. Dysplasia can only be detected by endoscopic biopsies. Patients with Barrett's esophagus should have regular surveillance exams in order to detect cancer early and may have a potential cure.
Q. How is Barrett's esophagus diagnosed?
The only way to confirm the diagnosis of Barrett's esophagus is with a test called an upper endoscopy.
While the appearance of the esophagus may suggest Barrett's esophagus, the diagnosis can only be confirmed with small samples of tissue (biopsies) obtained through the endoscope.
Q. How is Barrett's esophagus treated?
The treatment of Barrett's esophagus is similar to the treatment of GERD. Treatment might begin with lifestyle changes, including:
Not eating certain foods that cause reflux
Not eating late in the evening
Not smoking
Treatment is also likely to include the use of medications that will decrease acid production by the stomach.
All patients with Barrett's esophagus who are in reasonably good health should undergo endoscopic surveillance at appropriate intervals:
Patients with no dysplasia (unusual changes or growths) on two endoscopies done one year apart should have a follow-up endoscopy done at 3-year intervals.
Patients with low-grade dysplasia should have a repeat endoscopy within 6 months and then every year until two in a row are negative before resuming surveillance at 3-year intervals.
Patients with high-grade dysplasia should have an endoscopy with meticulous biopsies and endoscopic resection (removal) of any mucosal abnormalities within 3 months to exclude unsuspected cancer.
Q. How is Barrett's esophagus with dysplasia or cancer treated?
Current treatments for Barrett's esophagus with dysplasia or cancer include photodynamic therapy, radiofrequency ablation, cryotherapy, endoscopic mucosal resection, or surgical removal of almost all the esophagus.
Photodynamic therapy combines a light-sensitizing substance (Photofrin) with the use of a laser. This is rarely used anymore due to the cost, side effects, and problematic long-term results.
Radiofrequency ablation. Results are promising for the treatment of low-grade dysplasia and high-grade dysplasia. The use of radiofrequency ablation for nondysplastic Barrett's esophagus is controversial at present.
Cryotherapy. This technique is still experimental and is currently under study.
Endoscopic mucosal resection.
Surgical treatment of Barrett's esophagus with cancer is used only when the patient is strong enough to handle the surgery and has high-grade dysplasia or cancer. Removal of the esophagus is the method of choice.
Q. How is Barrett’s Esophagus prevented?
Diagnosis and treatment of GERD may help to prevent Barrett’s esophagus. It may also help keep the condition from progressing.
Lifestyle changes can ease symptoms of GERD, which may underlie Barrett's esophagus.
Feb 22, 2021
HUNG M. DO, MD, Ph.D