Barrett'S Esophagus

Barrett's esophagus is a disorder in which your esophageal lining, damaged by stomach acid, is replaced with a tissue that is identical to your intestinal lining.

This process is called intestinal metaplasia. This condition is commonly seen in people with a long-term problem of gastroesophageal reflux disease (GERD) — a chronic regurgitation of acidic fluids from the stomach into the lower esophagus.

It has been estimated through research that only 1.6-6.8% of people develop Barrett's esophagus (that includes only a small percentage of people with GERD.)

Risk factors

Individuals with Barrett's esophagus are more likely to be associated with an increased risk of developing a rare type of cancer called esophageal adenocarcinoma.

Although the risk of developing esophageal adenocarcinoma in people with Barrett’s esophagus is about 0.5% per year, it is very important to have regular checkups for precancerous cells.

Usually, precancerous cells appear in the Barrett's tissue before the cancer develops.

If precancerous cells are found during a checkup, treatment is available to prevent esophageal cancer.

The tissue changes that occur from Barrett's esophagus do not cause any signs or symptoms.

The signs and symptoms that you have are often because of acid reflux, and may include:

• Frequent heartburn
• Regurgitation of bitter tasting fluid and nausea
• Difficulty swallowing food
• Less commonly, chest pain

The regurgitated fluid may sometimes gain entry into your lungs or voice box (larynx), resulting in extraesophageal manifestations of GERD that include:

• Frequent bronchitis with chronic cough
• Sore throats
• Hoarseness of voice

If you have had problems such as heartburn and acid reflux for more than five years, consult your doctor to check whether you have Barrett's esophagus.

Seek immediate medical attention if you have:

• Chest pain, which may be a symptom of a heart attack
• Difficulty swallowing
• Vomiting of red blood or blood that appears similar to coffee grounds
• Black, tarry or bloody stools

Doctors do not know the exact cause of Barrett's esophagus.

Most people with long term gastroesophageal reflux disease (GERD) are more likely to develop Barrett's esophagus. It is more common in men than women.

Normally, when eating, food passes from your throat into your stomach through the swallowing tube, also called the esophagus.

A ring of muscle fibers located at the lower esophagus avoids stomach contents from moving backwards.

If the muscles do not close properly, stomach acids may wash back into the esophagus. This is called acid reflux or gastroesophageal reflux, which causes damage to the esophageal tissue over time.

During the healing process, the cells change over to the type of cells found in Barrett's esophagus.

However, some people who have been diagnosed with Barrett's esophagus have never got symptoms such as heartburn or acid reflux.

It is still obscure what causes Barrett's esophagus in these people.

Barrett's esophagus is usually diagnosed in people with GERD who are undergoing examination for its complications.

If your doctor recognizes Barrett's esophagus during an endoscopy exam, you may be referred to a doctor who treats digestive diseases (gastroenterologist).

Always ask for any pre-appointment restrictions, such as avoiding solid food on the day before your appointment.

Make a list of the following information:

• All symptoms, including those that seem unrelated to the current condition.
• All regular medications, vitamins, and supplements.
• Key medical information
• Ask a relative or friend to come along with you to the appointment so that they can remember some information that you have missed or forgotten.

    Questions to ask your doctor may include:

• Do my laboratory reports show abnormal tissue (dysplasia)? If so, what is the grade of my dysplasia?
• How much of my esophagus is affected?
• How often should screening tests be done for changes to my esophagus?
• What is my risk of esophageal cancer?
• What are my treatment options?
• Do I need to restrict my diet or make other lifestyle changes?
• How can I best manage my other health conditions?

      Your doctor is likely to ask you a number of questions such as:

• When did you first notice your symptoms?
• What is their severity?
• Are your symptoms continuous or occasional?
• Does anything seem to improve or worsen your symptoms?
• Do you experience symptoms of acid reflux?
• Do you take medications for reflux or indigestion?
• Do you feel difficulty swallowing food?
• Did you notice any weight loss recently?

Endoscopic examination is generally used to determine Barrett's esophagus.

A lit tube with a camera at the end (endoscope) is passed down the throat to detect signs of changing esophagus tissue.

Normally, esophagus tissue appears pale and glossy, but with Barrett's esophagus, the tissue turns red and velvety in texture.

Your doctor may remove a small tissue sample (biopsy), which can be examined under a microscope to determine the degree of tissue change:

Determining the degree of tissue change: A doctor specializing in examination of tissue in a laboratory (pathologist) determines the degree of dysplasia in your esophagus cells.

Your tissue may be classified as:

• No dysplasia: No precancerous changes are found in the cells, but Barrett's esophagus is present.
• Low-grade dysplasia: If there are small signs of precancerous changes in the cells.
• High-grade dysplasia: Many changes occur in the cells. High-grade dysplasia is thought to be the final step before cells transform into esophageal cancer.

The best treatment option for Barrett's esophagus is chosen based on the severity of dysplasia found in your esophagus cells and your overall general health.
  

No dysplasia or low-grade dysplasia: Your doctor will likely recommend:

• A periodic surveillance endoscopy to monitor the cells in your esophagus: Your doctor may perform an upper gastrointestinal endoscopy with a biopsy in a periodic manner to check for signs of cancer development. If your biopsy reveals no signs of dysplasia, you will probably have a follow-up endoscopy every year and thereafter, once in three years if no changes occur. If low-grade dysplasia is found in the biopsy, your doctor may advise another endoscopy in six months or a year.

Treatment for GERD

Medications and lifestyle changes can reduce your signs and symptoms of GERD.

Acid-suppressing medications called proton pump inhibitors (PPIs)may be prescribed.

These medicines prevent further damage to your esophagus and, in some cases, cause healing of the existing tissue damage.

PPIs include omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), lansoprazole (Prevacid), rabeprazole (AcipHex), esomeprazole (Nexium), and dexlansoprazole (Dexilant).

Anti-reflux surgery that is performed to tighten the sphincter and controls the flow of stomach acid may be an option.

Treatment of GERD does not get rid of the underlying Barrett's esophagus, but detection of dysplasia can be made easier.

High-grade dysplasia

High-grade dysplasia is believed to be a precursor to esophageal cancer.

Your doctor may recommend:

• Endoscopic mucosal resection: With this technique, your doctor will lift the Barrett’s tissue, then inject a solution underneath or apply suction to the tissue followed by removal of the tissue using an endoscope. You will be given a local anesthesia to numb your throat and a sedative to help you stay relaxed and comfortable during the procedure.
• Radiofrequency ablation: Radiofrequency ablation may be performed after endoscopic resection. This technique uses radio waves to kill the precancerous and cancerous cells present in the Barrett’s tissue. An endoscope or electrode mounted on a balloon produces heat that destroys the Barrett’s tissue.
• Cryotherapy: In this technique, an endoscope applies a cold liquid or gas to the abnormal tissues in the esophagus. These cells are then allowed to warm up and be frozen again. The cycle of freezing and thawing causes damage to the abnormal cells.
• Photodynamic therapy: Photodynamic therapy makes use of a light-activated chemical substance called porfimer (Photofrin), an endoscope, and a laser to kill the precancerous cells in your esophagus. Your doctor will initially inject porfimer into a vein in your arm, and after 24-72 hours, you have to return to complete the procedure. This therapy kills the abnormal cells by making them sensitive to light.
• Surgery: A surgical procedure called esophagectomy is performed as an alternative to endoscopic therapy. Esophagectomy involves removal of the affected portions of your esophagus. After the affected section of your esophagus is removed, your surgeon will rebuild the esophagus from a tissue segment taken from your stomach or large intestine. You will be administered general anesthesia during the procedure, and you will need to stay in the hospital for about 2 weeks following the surgery.

Lifestyle modifications can reduce symptoms of GERD, which may lead to Barrett's esophagus.

Consider the following lifestyle changes:

• Maintain a healthy weight.
• Avoid wearing tight clothes that may aggravate the reflux by putting pressure on your stomach.
• Reduce intake of fatty foods or drinking beverages that trigger heartburn. Foods to be avoided include: chocolates, coffee, spicy foods​, tomatoes and tomato products, and peppermint
• Eat small, frequent meals instead of three large meals
• Quit smoking
• Avoid bending, lying down, or stooping soon after eating.
• Elevate the head portion of your bed to about 6-8 inches by placing wooden blocks under your bed

If you have been diagnosed with Barrett's esophagus, you may worry about your risk of esophageal cancer.

However, the risk of developing cancer is very small. If you experience anxiety, consider:

• Performing activities such as listening to music or any other activity that helps you relax
• Adopt healthy lifestyle choices to ease GERD symptoms, and improve your general health

Risk factors that are involved in increasing your risk of Barrett's esophagus include:

• Chronic heartburn and acid reflux: If you have had symptoms of GERD for more than five years, it can increase your risk of developing Barrett's esophagus.
• Age: Barrett's esophagus can occur at any age but is more common in elderly people above the age of 50. You will be at a higher risk if you are at 30 or younger when chronic GERD develops first.
• Gender: Barrett's esophagus affects men more commonly than women.
• Race and complexion: White skinned people have a greater risk of Barrett's esophagus than do people of other races.
• Being overweight: Excessive body fat deposition around your stomach may increase your risk.
• Smoking

Complications of Barrett's esophagus
 

Esophageal cancer: People with Barrett's esophagus are at an increased risk of developing esophageal cancer.

The risk is very small in people whose biopsy tests show no precancerous changes (dysplasia) in esophagus cells.

Most people with Barrett's esophagus may never develop esophageal cancer.