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What is Barrett’s Esophagus?
Barrett’s Esophagus occurs when abnormal growth of intestinal-like cells form
in the lining of the esophagus. The lining of the esophagus differs from that of the stomach
and intestines, and is different in appearance, so it is usually easy for your physician
to determine if such abnormal growth has occurred. It is believed that the abnormal growth
that causes Barrett’s is actually one of the means by which the body responds to injury.
Unfortunately, the growth of these cells leads to a condition that increases the risk for a form of cancer found in the lower esophagus known as adenocarcinoma.
What symptoms will
I experience if I have Barrett’s
Esophagus?
While there are cases of Barrett's Esophagus being present at birth, the most common
reason for developing Barrett's Esophagus is the presence of chronic GERD. Therefore, patients
with Barrett's Esophagus will experience the same symptoms as patients with GERD: heartburn,
regurgitation and an acid/sour taste in the back of the mouth. Patients who have developed
Barrett's Esophagus may experience some of the more serious side effects of GERD, such as
esophageal peptic ulcers and stricture, or the narrowing of the esophagus due to scarring.
How
is it diagnosed?
If you, or your doctor, feel that you may be at risk for Barrett's Esophagus, an
upper endoscopy or EGD ( esophagogastroduodenoscopy) will be performed. This is when a small,
flexible tube that has a light and a camera is inserted orally and travels down your esophagus,
where your physician can view the cells that line your esophagus. In addition, biopsies can
be taken that will be studied by a pathologist to determine the changes, or dysplasia, that
has occurred. Generally, your physician will want to repeat the procedure at regular intervals
in order to properly monitor the changes that occur in your esophagus.
What is the treatment process for Barrett's Esophagus?
The treatment process for Barrett's Esophagus is similar to that of GERD, however, treatment
becomes even more important when you have become diagnosed with Barrett's Esophagus, as your
esophagus is already beginning to make changes that can affect your long-term health. It
is felt that the best method of treating Barrett's Esophagus is to treat the underlying symptoms.
This can be achieved through a variety of methods.
There are medications that can help to control your reflux.
Proton pump inhibitors, which reduce the production of gastric acid, are the mainstay of
therapy. They include Prilosec©, Prevacid©, Protonix©, Aciphex© and
Nexium©. These medications
are generally taken once or twice per day and may be a required treatment throughout your
life.
A change in diet and lifestyle to eliminate foods and behaviors,
such as smoking, may reduce reflux. Obesity may be a contributing factor. Unfortunately,
eliminating the necessary foods, and completely controlling reflux through diet modification
is extremely difficult.
There are two important factors in treating Barrett's Esophagus—treating the symptoms
and treating the problem.
The problem in patients with Barrett's Esophagus, similar to those with other forms of
reflux disease, is a malfunctioning lower esophageal sphincter. This valve controls the passage
of food from the esophagus into the stomach. When it is weak it does not close properly allowing
food, acid, bile and other substances to pass back into the esophagus causing GERD and Barrett's
Esophagus. Many patients have a normal pressure in the sphincter muscle, but suffer because
of the excessive number of times the muscle relaxes. The symptoms of GERD, including those
with Barrett's Esophagus, may be controlled with medication and diet modification. Occasionally,
patients may suffer from nonaciditic reflux and may require more aggressive treatment.
Additional Treatment Strategies:
Laparoscopic Nissen fundoplication
- This is a surgery done to treat reflux.
Five small incisions are made in the abdomen, where cameras and surgical instruments are
placed. The fundus of the stomach is wrapped around the lower portion of the esophagus. This
will create a new "valve" between
the esophagus and stomach to prevent reflux from occurring.
Endoscopic procedure
- Ablation: Endoscopic ablation
techniques involving thermal destruction of the abnormal lining cells in the esophagus are
now available for patients with cellular changes of either early cancer or highly precancerous
characteristics.
What happens if Barrett's Esophagus is not treated?
If left untreated,
Barrett's Esophagus may progress to cancer. The intestinal cells that line the esophagus
can change from normal, to dysplasia (abnormal) to cancer (malignant). Why these cells continue
to progress is not well understood. However, once dysplasia is present, a patient has a 0.5%
risk per year of going on to develop cancer in the esophagus. Diligent surveillance and aggressive
treatment may reduce the further development of Barrett’s
esophagus and allow for early diagnosis of premalignant or malignant changes.
Where can I learn more about Barrett's Esophagus?
Where can I find a support group?
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