BARRETT’S ESOPHAGUS

What Is Barrett’s esophagus?

Barrett’s esophagus is when normal tissue in the esophagus is replaced by tissue similar to the intestinal lining. It is often diagnosed in patients who have long-term gastroesophageal reflux disease (GERD).

What is GERD?

GERD is the chronic regurgitation of acid from the stomach into the esophagus.

What are the symptoms of Barrett’s esophagus?

Patients with Barrett’s esophagus may have no symptoms whatsoever. Some patients may have symptoms related to GERD which include burning sensation in the chest, regurgitation of food or sour liquid, difficulty swallowing, and chest pain. It is important to remember that patients can have silent reflux (having GERD but not be symptomatic) and develop Barrett’s esophagus.

What causes Barrett’s esophagus?

The exact cause is not completely understood but the majority of patients with Barrett’s esophagus have long-standing GERD. In GERD, acidic fluid washes back into the esophagus from the stomach and damages the normal esophagus tissue. As the esophagus heals, the damaged cells can change into those cells seen in Barrett’s esophagus.

What are the complications of Barrett’s esophagus?

Patients with Barrett’s esophagus have a small increased risk of esophageal cancer. The majority of patients with Barrett’s esophagus will not develop esophageal cancer, but Barrett’s esophagus is considered a pre-cancerous condition.

What are the risk factors for Barrett’s esophagus?

Chronic acid reflux is the main risk factor for developing Barrett’s esophagus. Other risk factors include:

• - Age greater than 50 years old
• - Being male
• - Being white
• - Being Overweight
• - Current or past smoking
• - Family history of Barrett’s esophagus or esophageal cancer

If you have chronic acid reflux and some or all of the risk factors mentioned above, speak to your gastroenterologist about screening for Barrett’s esophagus.

How is Barrett’s esophagus diagnosed?

An endoscopy needs to be performed and the esophagus tissue needs to be biopsied to confirm a diagnosis of Barrett’s esophagus. In an endoscopy, a long tube with a light and camera on the end (called an endoscope) is passed through the mouth, down the throat, and into the esophagus.

What are the treatments for Barrett’s esophagus?

The treatment is determined by the extent of changes seen in the esophagus cells when looked at under a microscope. A pathologist, the doctor who examines the esophagus tissues cells, determines how much dysplasia is seen in the cells. Dysplasia, or the amount of precancerous change, is graded as being low-grade or high-grade.

If there is no dysplasia, the goal is to treat GERD with medication and lifestyle changes. Periodic endoscopy to monitor for any further changes in the esophagus cells is also recommended. Endoscopy is usually repeated every 3 to 5 years if there is no dysplasia.

If there is low-grade dysplasia, two potential options are available. One option is to treat GERD with medications and lifestyle changes and repeat an endoscopy in 12 months. The other option is to endoscopically treat the area of Barrett’s esophagus given in the increased risk of developing esophageal cancer.

If there is high-grade dysplasia, there is a higher chance of developing esophageal cancer, therefore endoscopic therapy is recommended

What are the endoscopic therapies for low-grade or high-grade dysplasia in Barrett’s esophagus?

The endoscopic therapies include:

• - Endoscopic resection – Small tools passed through the endoscope are used to remove the abnormal cells
• - Radiofrequency ablation (RFA) – This is an FDA-approved technique where heat energy is used to destroy the abnormal cells. When the area heals, the abnormal cells are replaced by normal esophageal cells. Oftentimes, a few sessions of radiofrequency ablation about 3 months apart are needed to fully remove the damaged cells.
• - Cryotherapy – This is an FDA-approved technique where cold liquid or gas is used to freeze the damaged cells. The cells are allowed to thaw and then frozen again. This freezing and thawing cycle destroys the abnormal cells. As with RFA, when the area heals, the abnormal cells are replaced by normal esophageal cell

The above endoscopic therapies are extremely successful at healing Barrett’s esophagus. Very rarely, surgery is needed, where the abnormal part of the esophagus is removed and the remaining portion is reconnected to the stomach.

Surveillance

Patients diagnosed with Barrett’s esophagus are placed in a strict surveillance protocol based on the most recent American College of Gastroenterology Guidelines. read more.