Barrett’s Esophagus
What is Barrett’s esophagus?
Barrett’s esophagus is a result of chronic acid-reflux induced injury and irritation of the lining of the lower portion of the esophagus. The normal flat cells that line the esophagus (squamous cells) become replaced by box-like cells more commonly found in the stomach or intestine (columnar cells). It is estimated that about 10 percent of patients with chronic GERD/reflux will develop Barrett’s esophagus. As 10 percent (or more) of American have regular reflux symptoms, this is a large number of patients. Barrett’s esophagus is a recognized risk factor for developing a type of cancer of the esophagus, known as adenocarcinoma.
What are the symptoms of Barrett’s esophagus?
Symptoms of Barret’s esophagus follow those of GERD/acid reflux, such as burning, indigestion, heartburn and pain, with the interesting observation that once Barrett’s esophagus changes to the esophagus occur, symptoms of heartburn may actually improve. This is due to the new cells, the columnar cells, having the ability to release bicarbonate to buffer stomach acid. While this response by the body is initially helpful, any change in cell nature (metaplasia) can induce further uncontrolled cellular changes. This is what cancer is, and it’s why Barrett’s is a risk for esophageal cancer.
How is Barrett’s esophagus diagnosed?
A careful history and physical exam are important parts to the diagnosis of Barrett’s esophagus. Endoscopy is the way to diagnose this condition, with characteristic visual changes seen during an upper endoscopy. The esophageal lining has a distinct appearance with this condition, and biopsies then are used to confirm the diagnosis as well as detect precancerous changes.
Risk factors for Barrett’s esophagus include chronic GERD/reflux, male sex, being over the age of 50, a history of smoking orobesity, and a family history of Barrett’s esophagus and/or esophageal cancer.
How is Barrett’s esophagus treated?
Treatment for Barrett’s esophagus is tailored to each patient, with the goal of choosing therapy that best matches each individual’s disease pattern and severity. Most patients with Barrett’s esophagus will never develop cancer nor other complications of this disease, but disease monitoring and surveillance with periodic upper endoscopy exams (typically every three to five years) is the key to identifying those patients who will go on to develop cancer.
If caught at a treatable stage, early esophageal cancer can be cured either through endoscopic or surgical techniques. Esophageal cancer is often not diagnosed until more advanced stages, however, and those cases have a worse outcome. This is why early detection and monitoring of Barrett’s esophagus is very helpful.
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