What is Barrett’s esophagus?
Barrett’s esophagus is the lining of the esophagus that becomes the lining of the small intestine instead of the esophagus. It occurs at the point where the esophagus meets the stomach.
Barrett’s esophagus is a serious chronic problem of Gastroesophageal reflux disease (GERD). Barrett’s esophagus is more common in people who have had GERD for a long time or who developed it at a young age.
It is significant that most people with GERD do not have such an abnormality. However, the presence of Barrett’s esophagus is an important consideration because those with it have a higher than normal risk of developing esophageal cancer.
- Barrett’s syndrome
Who gets Barrett’s esophagus?
People who develop Barrett’s esophagus are:
- Middle-aged or older
They may also have:
- Family history of Barrett’s esophagus or esophageal cancer
- Heartburn symptoms for 10-plus years
- Gastroesophageal reflux disease (GERD)
Causes of Barrett’s esophagus
Barrett’s esophagus is caused by chronic exposure to stomach acid. When you have gastroesophageal reflux disease (GERD), acid from your stomach enters your esophagus. This frequent exposure to acid can cause inflammation and damage to the cells of the esophagus.
Over time, your esophagus tries to heal itself by generating new cells that are found in your intestines. This is diagnosed when this process occurs. It’s important to diagnose the condition as early as possible so that effective treatment can help prevent these cells from turning cancerous.
Risk factors for Barrett’s esophagus
Risk factors for Barrett’s esophagus include:
- Possible genetic predisposition
Symptoms of Barrett’s esophagus
It does not cause Barrett’s esophageal symptoms. This may be associated with associated GERD problems. See a gastroenterologist if you experience the following symptoms for more than two weeks:
- Blood in vomit or stool
- Difficulty swallowing solid foods
- Nocturnal regurgitation (acidic or bitter liquid getting up to the chest or mouth throughout the night)
- Unintentional weight loss
- Regular sore throat, sour taste in your mouth, or bad breath
Diagnosis of Barrett’s esophagus
Barrett’s esophagus is diagnosed by endoscopy and biopsy of the upper gastrointestinal tract. Upper GI endoscopy involves viewing the upper GI tract with an endoscope, a small, flexible tube with light. The test is performed by a gastroenterologist, a doctor who specializes in digestive diseases, in a hospital or patient center.
The endoscope is carefully inserted into the esophagus and into the stomach and duodenum. A small camera mounted on an endoscope transmits a video image to the monitor, allowing it to closely examine the intestinal lining. A person can gargle or spray a liquid anesthetic in the back of the throat. The intravenous (IV) needle is placed intravenously under general anesthesia. The test may show changes in the lining of the esophagus.
This is difficult to diagnose because not all tissues in the esophagus are affected. Although the gastroenterologist took biopsy samples (using an endoscope) from multiple areas of the lining of the esophagus, the part of the esophagus that contains the cells shows the condition. When viewed through an endoscope, Barrett’s tissue does not always look different than normal tissue, so the difference is often only visible under a microscope.
The pathologist, who specializes in diagnosing disease, examines the tissue in the laboratory under a microscope to see if Barrett’s esophageal cells are present. A specialist pathologist who specializes in diagnosing this condition needs to further verify the test results.
Treatment for Barrett’s esophagus
Barrett’s esophagus does not go away on its own. It can be treated with endoscopic therapies or surgery. The goal of these procedures is to kill Barrett’s cells and any dysplasia and cancer cells, promoting normal esophageal tissue to grow back as this area heals.
There are several endoscopic treatments available for the treatment of acute dysplasia and cancer:
- Photodynamic therapy (PDT): PDT uses a light-sensitizing agent (photofrin) and a laser to kill abnormal cells. Photofrin is injected intravenously and the patient returns after 48 hours. The scope is then inserted into the esophagus, and the laser light activates the photofrin, which destroys Barrett’s tissue.
- Endoscopic mucosal resection (EMR): EMR is a procedure in which the lining of the pin is lifted and a solution is injected under it. Then the lining is removed using an endoscope. If EMR is used to treat cancer, endoscopic ultrasound is used to find out if you only have a layer on top of the cancer cells.
Surgical options may be considered if cancer has been diagnosed or the dysplasia is severe.
- Esophagectomy: The most common surgical procedure for Barrett’s esophagus is to remove most of the esophagus, push part of the abdomen into the chest, and attach the rest to the esophagus.
Barrett’s esophagus can be prevented by avoiding risk factors:
- Maintain a healthy body weight through regular exercise and a balanced diet
- Eliminating foods that cause heartburn and gastric problems such as coffee, alcohol, mint
- Using wedge pillows to lift your head while sleeping to prevent the backflow of gastric contents
- Give up smoking
- Eat soft and easily digestible foods
Possible complications from all of these processes can include chest pain, narrowing of the esophagus, incisions in the esophagus, or rupture of the esophagus
When to contact the doctor
If you have any of the risk factors listed above, you should ask your doctor about Barrett’s esophagus (male, 50 years or older, Caucasian ethnicity, GERD symptoms lasting more than 10 years). If you have alarm symptoms such as difficulty swallowing, weight loss without trying, blood in your stool, vomiting, persistent symptoms despite medical treatment, or new chest pain, you should discuss your symptoms with your doctor and undergo an endoscopic examination.
Departments to consult for this condition
- Department of Gastroenterology