Barrett’s Esophagus – The Hidden Danger

Barrett’s esophagus is a pathological condition in which the cells of esophagus change to more closely resemble the cells of the intestines. This the result of exposure to acid from the stomach after years of gastroesophageal reflux (GERD). There is a risk of Barrett’s esophagus developing into esophageal cancer.

What causes Barrett’s esophagus?

The cause of Barrett’s esophagus is not completely understood, but it is most often seen in people with GERD.GERD happens when the muscles at the bottom of the esophagus fail to completely prevent food and acid from coming back up into the esophagus. We think that the cells in the esophagus become abnormal due to the long-term exposure to stomach acid.

Although Barrett’s esophagus can develop without GERD, patients with GERD are three to five times more likely to develop Barrett’s esophagus.Approximately five to ten percent of patients with GERD develop Barrett’s esophagus. Men are almost twice as likely to get it as women. It is usually diagnosed after age 50.

The cells of the esophageal lining may develop into precancerous and then into cancer cells. About half a percent of people with Barrett’s esophagus develop cancer.

What are the risk factors?

Longstanding GERD (symptoms for longer than 10 years) puts a person at greater risk of developing Barrett’s esophagus.Other risk factors include being an older white male, obesity, smoking and H pylori gastritis. Smoking, aspirin, and alcohol use can make Barrett’s esophagus worse. Large meals high in saturated fats and spicy foods are also known to aggravate GERD. Patients are advised not to lie horizontally for up to fourhours after eating.

Symptoms of Barrett’s esophagus

Barrett’s esophagus does not have any symptoms, but the heartburn associated with GERD should alert the sufferer to the possibility. More serious symptoms that indicate that immediate medical attention might be necessary include chest pain, vomiting blood, difficulty swallowing, and passing black, tarry, or bloody stools.

Diagnosis of Barrett’s esophagus

Definitive diagnosis is achieved through endoscopy which allows the doctor to see the inside of the esophagus. (For an illustrated explanation designed to help the layman understand endoscopy, check out the website of any major gastroenterology clinic like Manhattan Gastroenterology.

The clinician may also take a tissue sample for microscopic examination. The pathologist will examine the tissue sample for dysplasia, i.e. abnormal cells. Dysplasia is an indication that the tissue may eventually develop into cancer.

Treatment of Barrett’s esophagus

Depending on the level of dysplasia, several options are available for treatment. If the patient has no or low-grade dysplasia, the symptoms of GERD may be managed medically with antacids.

With higher grade dysplasia, two surgical options are commonly recommended, Nissen fundoplication and LINX. Nissen fundoplication strengthens the lower esophageal sphincter by wrapping the top of the stomach around the outside of the sphincter. LINX is a procedure in which a device made up of small metal beads is emplaced around the lower esophagus to help keep stomach contents from leaking into the esophagus.

The Stretta procedure, which uses radio waves to induce changes in the muscles of the esophagus and thereby decrease acid reflux, is another option.

In the case of high-grade dysplasia, damaged areas of the esophagus may have to be removed. Sometimes this can include large portions of the esophagus. Abnormal cells can also be killed using radiofrequency ablation, cryotherapy, and photodynamic therapy.

None of these procedures are without risk. Possible complications include chest pain, narrowing of the esophagus, cuts in or rupture of the esophagus. Overall, the chance of developing cancer with Barrett’s esophagus is low, but the efficacy of avoiding the condition through lifestyle changes is high.