What Is Barrett’s Esophagus?
Barrett’s esophagus is a rare condition that affects the tube that connects the mouth to the stomach. In Barrett’s esophagus, the lining of the esophageal tube changes to resemble the tissue that lines the intestinal tract. This transition is referred to as intestinal metaplasia.
How Common Is Barrett’s Esophagus/Who Is Likely to Develop Barrett’s Esophagus?
Barrett’s esophagus is not a common condition. Approximately 1.6 to 3 percent of the population develops this potentially serious disease. While it is not completely known what causes the condition, risk factors have been identified. These include:
- Chronic GERD, or gastroesophageal reflux disease. This is another term for acid reflux and heartburn. GERD involves the regurgitation of stomach acid into the lower esophagus. Even in the presence of GERD, Barrett’s esophagus is uncommon.
- More men develop Barrett’s esophagus than women.
- Older individuals have a higher risk for this condition.
- More diagnoses are made in Caucasians than other races.
- Obesity may increase the risk for Barrett’s esophagus, as does smoking.
What Are the Symptoms of Barrett’s Esophagus?
There are no direct symptoms that indicate the change in the esophageal lining, only the symptoms of GERD, which include:
- Frequent heartburn, a burning sensation in the chest, usually after meals.
- Regurgitation of food or liquid.
- Difficulty swallowing food.
- A chronic cough.
- The sensation of a lump in the throat.
- Chest pain (less common).
If you have experienced the symptoms of GERD for more than a few years, speak with your doctor about screening for Barrett’s esophagus.
What Causes/Increases My Chances of Developing Barrett’s Esophagus?
Thus far, studies indicate that the strongest factor in developing Barrett’s esophagus is long-term GERD. The frequency and intensity of acid reflux are less concerning than the longevity of symptoms. Therefore, any triggers that provoke ongoing GERD could increase the risk of developing Barrett’s esophagus. Potential triggers include:
- Going to bed too soon after eating, especially heavy meals.
- Consuming foods and beverages that trigger acid reflux, including fried foods and coffee.
How Do You Diagnose Barrett’s Esophagus?
An instrument called an endoscope is used to observe the lining of the esophagus for changes that indicate Barrett’s esophagus. The endoscope is a flexible tube that is inserted through the mouth into the esophagus and possibly into the stomach. The lighted camera on the end of the tube projects images of relevant structures onto a monitor. If the lining of the esophagus appears to be abnormal, a biopsy will be taken to examine a small sample of tissue under a microscope. Normal esophageal tissue appears pale and glossy. Tissue that is red and textured may indicate Barrett’s esophagus.
Both the endoscopic examination and the biopsy are safe and rarely cause discomfort or complications. Results of biopsy testing are typically available within a few days.
Treatment for Barrett’s Esophagus
Treatment is recommended based on the degree of tissue change within the esophagus. When little to no tissue change has occurred, treatment may revolve around controlling GERD with medication and lifestyle modifications. Patients may manage GERD by quitting smoking, eliminating foods that trigger acid reflux and heartburn, maintaining a healthy weight, and sleeping at a slight incline. A minor surgical procedure may be suggested to tighten a loose esophageal sphincter muscle to reduce acid reflux.
In addition to treatment for GERD, your doctor may recommend periodic endoscopy screening to monitor the lining of your esophagus for dysplasia. Follow-up endoscopy may be performed one year after the first, and then every three years if no dysplasia is found.
Are People with Barrett’s Esophagus More Likely to Develop Dysplasia or Cancer?
How Is Barrett’s Esophagus with Dysplasia or Cancer Treated?
Treatment depends on the extent of dysplasia. This is generally confirmed by a second pathology evaluation.
- A follow-up endoscopy may be scheduled six months after the initial diagnosis. Additional endoscopic exams may be scheduled at six to 12-month intervals.
- Endoscopic resection of the esophagus may be performed to remove abnormal cells.
- Radiofrequency ablation may be performed after resection to remove any abnormal cells that remain.
- Endoscopic resection and radiofrequency ablation may be performed to remove cells.
- Photodynamic therapy destroys abnormal cells by causing light sensitivity.
- Cryotherapy is the process of destroying cells with cold gas or liquid.
- Surgery may be performed to remove the affected portion of the esophagus.