Barrett's Esophagus

Definition

The esophagus is a tube that carries food from your mouth to your stomach. Barrett esophagus is a change to the cells of this tube.

This change means there is a higher risk of cancer developing. Treatment can lower the risk or catch cancer early.

Causes

The exact cause of Barrett esophagus is not known. Regular, long term damage and inflammation to the area may play a role. A back up of stomach acid into the tube is the most common cause of damage. This is also known as heartburn or gastroesophageal reflux disease (GERD).

Gastroesophageal Reflux

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Risk Factors

Barrett esophagus is more common in people aged 50 years and older. Other factors that may increase your chance of Barrett esophagus include:

• Chronic heartburn or a history of GERD
• Obesity , especially around the midsection
• Current or history of smoking
• Family history of Barrett esophagus or esophageal cancer

Symptoms

Barrett esophagus does not cause symptoms itself.

It is common to have symptoms of stomach acid reflux such as:

• Heartburn
• Regurgitation
• Sore throat or chronic cough
• Hoarse voice
• Sour taste in mouth from acid reflux

Diagnosis

The doctor will ask about your symptoms and past health. A physical exam will be done. The doctor may want to test for Barrett esophagus if you have a history of GERD.

The area will need to be closely examined. Tests may include:

• Upper GI endoscopy—a scope is passed down the throat. A camera will allow the doctor to see any abnormal areas
• Biopsy—a sample of abnormal tissue is removed. It will be examined in a lab. This will show changes to the cells.

There is a range of cell changes. High grade changes are at greater risk of cancer.

Treatment

The cell changes that have already occurred can not be changed. The goals of treatment are to stop more damage to the area. The medical team will also remove high risk cells and check often for risk of cancer. Treatment options for Barrett esophagus may include:

Manage Reflux

Medicine may help to control reflux. The most common choice is proton pump inhibitors (PPIs). PPIs help control symptoms and slow or stop further damage.

Surgery

Surgery may be needed to treat severe GERD or remove unhealthy cells. Options include:

Fundoplication

This surgery can help to control severe GERD. A part of the stomach is wrapped around the esophagus. It will help to keep stomach acid in the stomach.

Endoscopic Eradication

A scope is passed down the throat. A camera will show the lining of the throat and abnormal cells. Tools can be passed down the scope to destroy abnormal cells. Normal cells can then grow over the area. There are different ways to kill the cells. Examples include:

• Photodynamic therapy—uses laser light
• Radiofrequency ablation—uses radiowaves

Esophagectomy

Part of the esophagus is removed. This may be needed for areas that have a very high risk of becoming cancer soon. The stomach may be pulled up or the area is replaced with a section of large intestine.

Monitoring

Follow up tests will be done to check for any new changes. They may be needed every 3 months to 5 years. The rate of follow up will depend on the type of cells that are present.

Prevention

The best way to prevent Barrett esophagus is to stop irritation of the tissue. Steps may include:

• Not smoking. If you smoke, talk to your doctor about steps to help you quit.
• Slow or stop acid reflux:
  • Lose excess weight .
  • Raise the head of your bed onto 4 to 6 inch blocks.
  • Avoid tight belts or waistbands.
  • Avoid foods that cause heartburn. Alcohol, caffeine drinks, chocolate, and fatty foods can cause problems. Spicy foods or those with acid such as citrus or tomatoes can cause problems too.
  • Do not eat or drink for 3 to 4 hours before you lie down or go to bed.