Understanding Barrett’s Esophagus
What is Barrett’s Esophagus?
Barrett’s esophagus, also known as Barrett syndrome or columnar epithelium lined lower oesophagus (CELLO), is a condition that evolves when the regular cells in the lining of the esophagus are replaced by cells that are more like those found in the intestinal tract in a process called metaplasia.
The actual causes of Barrett’s esophagus are unclear, but the condition is most often associated with gastro esophageal reflux disease (GERD). GERD causes chronic regurgitation of stomach acid into the lower part of the esophagus, resulting in inflammation and damage over time. Patients with GERD are more likely than others to develop Barrett’s esophagus, but the two conditions are not always concurrent.
Though most people with Barrett’s esophagus are asymptomatic, some may experience uncomfortable symptoms such as frequent heartburn, difficulty swallowing, chest or upper abdominal pain and pain when eating.
Who should be screened?
There are no specific criteria dictating who should be screened for Barrett’s esophagus. However, the condition is more prevalent in men, especially Caucasian men, than in women and appears to have a correlation with central obesity. Long-term GERD or persistent heartburn, hiatal hernia and being over the age of 50 are also potential risk factors. The American Gastroenterological Association recommends that people with a combination of these factors be screened as a precaution.
How do doctors test for it?
Barrett’s esophagus is diagnosed with an upper GI endoscopy. In this procedure, a doctor inserts a long, flexible tube known as an endoscope into the mouth and down into the esophagus. A lighted camera on the end of the scope transmits images of the interior of the digestive tract onto a monitor. Cellular changes that characterize Barrett’s esophagus will be visible if the condition is present, and the doctor will take a biopsy to confirm his or her findings and to check whether or not abnormal cell changes have progressed to a state known as dysplasia.
What is dysplasia?
Dysplasia is a precancerous tissue change that may be classified as indefinite, low-grade or high-grade. In order to diagnose how much, if any, dysplasia is present, a doctor must examine the biopsied cells from the endoscopy under a microscope.
- Low-grade dysplasia indicates that only minor cell changes have occurred and the overall pattern of cell growth remains normal.
- High-grade dysplasia is more serious with most cells exhibiting change along with a change in cell growth patterns.
- Indefinite dysplasia is used to describe cells with changes that may or may not be dysplasia. These changes can sometimes appear as a result of inflammation.
Since dysplasia can be a precursor of esophageal cancer, it’s a good idea to get a second opinion if a diagnosis is indefinite or otherwise questionable.
What is the link between Barrett’s Esophagus and cancer risk?
Barrett’s esophagus is an important risk factor for a type of esophageal cancer called esophageal adenocarcinoma. This cancer appears most frequently in those who suffer from GERD. Five to 15 percent of GERD patients develop Barrett’s’ esophagus which in turn increases their cancer risk. However, the overall occurrence of esophageal cancer in individuals with Barrett’s is only about 0.5 percent per year, or one person out of 200. By monitoring the development or progression of dysplasia, doctors can determine whether or not patients with Barrett’s esophagus are at an increased risk for cancer.
How often should an endoscopy be performed?
Frequency of screening depends upon the amount and severity of dysplasia. If no abnormal cell changes are detected, a doctor will likely recommend a one-year follow-up. Patients with low-grade dysplasia may be advised to have another endoscopy in six months to a year. High-grade dysplasia is a more serious condition that may be directly addressed with special treatments or surgery.
What are the available treatments?
In cases where Barrett’s esophagus is a result of GERD, patients are often given medications such as proton pump inhibitors (i.e. Prilosec, Prevacid) to reduce the amount of acid that the stomach produces. Other medications that speed the movement of food from the stomach to the intestines may also be prescribed. However, these treatments don’t directly address Barrett’s esophagus or lower cancer risk.
Several procedures are available to destroy or remove damaged esophageal cells. An endoscopic mucosal resection involves lifting the damaged part of the lining and cutting it off with the aid of an endoscope. This same procedure may be used to remove early stage cancerous cells.
Other procedures include radiofrequency ablation, which uses heat to destroy Barrett’s cells; cryotheraphy, which uses cold for the same purpose; and photodynamic therapy (PDT), in which doctors inject the patient with a light-activated chemical before exposing precancerous cells to a laser. The chemical makes the cells more light-sensitive and results in cell death when the laser is applied.
All surgical procedures carry potential risks such as pain, bleeding and narrowing or tearing of the esophagus. These side effects should be weighed against patients’ potential cancer risk before any surgery is performed.
Managing Barret’s Esophagus
Simple changes in diet and lifestyle can help control symptoms associated with Barrett’s esophagus and do not pose the same risk as medical interventions. For patients who experience the unpleasant effects of GERD, the following changes may be beneficial:
- Maintaining a healthy weight decreases pressure on the lower esophageal sphincter, the opening which controls the flow of food into the stomach, thus reducing the potential for reflux.
- Patients should eliminate irritating foods such as coffee, alcohol, citrus fruits and spicy foods. Eliminating allergenic foods also reduces irritation.
- Eating smaller meals and combining vegetables with protein separately from starches and sugars can make digestion easier.
- Supplementing with digestive enzymes and probiotics supports digestion.
- Certain herbs and supplements such as glutamine, deglycerized licorice and limonene help soothe and heal the digestive tract.
- Blocks may be placed under the headboard of the bed to control nighttime heartburn.
These and other basic interventions, along with the supervision of a doctor, can help reduce acid damage and aid patients in managing a diagnosis of Barrett’s esophagus.