Barrett's esophagus

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 17, 2016
StartBarrett's esophagus

When a person has gastroesophageal reflux disease (GERD), it can develop into Barrett's esophagus. A person's esophagus is the tube that carries food from the mouth to stomach. When someone develops Barrett's esophagus, the normal tissue lining in the esophagus changes, increasing the person's risk of developing esophageal cancer.

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Definition & Facts

With Barrett's esophagus, stomach acid, bile, and the contents of a person's stomach damage the lower cells of their esophagus. It is often associated with an increased risk for developing a type of esophageal cancer called esophageal adenocarcinoma. Research has shown that Barrett's esophagus is experienced by about 6% of individuals in the United States.

Men are at a greater risk for developing Barrett's esophagus than women. Caucasian men have a greater chance of developing this condition than any other demographic. The average age of a person diagnosed with Barrett’s esophagus is 55 years old. It is uncommon for children to develop it. If a person has struggled with having acid reflux disease for over five years, they need to ask their physician if they are at risk of having Barrett's esophagus.

Symptoms & Complaints

When a person has Barrett's esophagus, the change in the tissue on his or her esophagus may not cause any symptoms. Additionally, Barrett's esophagus may cause symptoms that are indistinguishable from other medical conditions.

Common symptoms include difficulty swallowing, frequent heartburn, and even chest pains. Unexplained weight loss could also be a symptom of Barrett's esophagus. Pain beneath a person's sternum where their esophagus meets their stomach is also an indication of Barrett's esophagus.

Additional symptoms include vomiting blood, particularly blood that looks like coffee grounds and passing stools that are tarry or black or bloody. Anyone experiencing these symptoms needs to discuss it with a physician.

Causes

The exact cause of Barrett's esophagus has not yet been identified. It is often seen among people who have GERD. It has been estimated that up to 10 percent of individuals who have GERD are at risk for developing Barrett's esophagus. GERD involves the muscles at the bottom of the esophagus becoming weak and unable to prevent food and acid from going back up into a person's esophagus. There has been research showing that the cells in a person's esophagus may become abnormal after long-term exposure to stomach acid. The esophagus will try and heal itself, and during this process, the cells can often change into cells that are identified as Barrett's esophagus.

There are also a number of situations where people are diagnosed with having Barrett's esophagus and have not experienced any type of acid reflux or heartburn. Researchers do not know what causes Barrett’s esophagus to develop with such people. Many physicians have connected people who smoke and are overweight with developing Barrett's esophagus. It is also common among people who eat fatty and spicy food as well as drink significant amounts of alcohol. It is most common among people who have had acid reflux for a number of years.

Diagnosis & Tests

It is recommended by the American Gastroenterological Association (AGA), that individuals who have a number of risk factors be screened for this condition. Since a person often shows no symptoms with Barrett's esophagus, its diagnosis requires a person to have an upper endoscopy and biopsy.

During the test, a gastroenterologist will place a long flexible tube containing a camera down into the throat of a patient. This is only done after the patient has been sedated. This procedure can cause great discomfort but typically does not cause any pain. Once the tube is in place in a person's esophagus, the gastroenterologist is able to perform a visual inspection using the camera. Still, this is not enough for a complete diagnosis.

The gastroenterologist will also need to remove a small sample of tissue from a person's esophagus. This sample will be carefully analyzed under a microscope in a laboratory. These two steps are the only way to confirm a diagnosis of Barrett's esophagus. The tissue sample will be analyzed to detect the presence of any precancerous cells or cancer. If the tissue sample shows signs of Barrett's esophagus, the gastroenterologist will recommend a follow-up endoscopy and tissue sample. This will be used to confirm the diagnosis.

Treatment & Therapy

There are a number of different treatments available for Barrett's esophagus. Radio waves sent into a person's esophagus is called radiofrequency ablation. This procedure makes it possible to kill abnormal cells and preserve the healthy ones underneath. A laser can be used to destroy abnormal cells without damaging healthy tissue. This procedure is called photodynamic therapy. Prior to the start of this procedure, a person will be given a drug called Photofrin®. This causes the esophageal cells to become sensitive to light.

There is also a procedure that applies cold carbon dioxide gas or cold nitrogen through an endoscope. This process is called cryotherapy and is designed to freeze any abnormal cells. There is also a procedure that removes any abnormal lining and lifts it from the esophagus wall. The lining is then able to be taken away by an endoscope. This is known as endoscopic mucosal resection. It will remove any cancer cells or precancerous cells discovered within the lining of a person's esophagus.

When there is severe pre-cancer cells or cancer cells detected, surgery to remove most of a person's esophagus may be required. Upon diagnosis, the earlier that surgery is performed, the greater the chance of a person being cancer-free.

Prevention & Prophylaxis

Preventive methods to avoid developing Barrett's esophagus involve individuals with heartburn/GERD becoming aware of their condition and getting examined early. The earlier stage testing will enable a person to have better treatment options and better results.

To prevent this condition from developing, it's also important for those who are overweight to to work on losing weight. Obesity can cause an individual to develop a hiatal hernia. This can result in acid reflux and an increased risk of developing Barrett's esophagus.

Physicians recommend their patients who are at risk for developing this condition not lie down after they eat. They also recommend these people sleep with their heads propped up. Lying down can result in acid reflux being exacerbated. Regularly using an antacid is also recommended.