Barrett's Esophagus

Definition

The esophagus is a tube that carries food from your mouth to your stomach. Chronic esophagitis is inflammation of the esophagus. Barrett esophagus is a complication of chronic esophagitis.

Barrett esophagus is a change in the cells that line the esophagus. Normal cells are flat-shaped squamous cells. Barrett esophagus cells are shaped like a column. This cell change is called metaplasia. It is a premalignant phase that may result in esophageal cancer if it is not treated.

Causes

The exact cause of Barrett esophagus is not known. It may result from damage to the esophagus caused by the chronic reflux of stomach acid. Frequent or chronic reflux of stomach acid into the esophagus is called gastroesophageal reflux disease (GERD).

Gastroesophageal Reflux

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Risk Factors

Barrett esophagus is more common in Caucasian men and 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

In some cases Barrett esophagus may not produce symptoms.

Some people with GERD may have the following symptoms:

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

More serious symptoms include:

• Difficulty or pain with swallowing, a condition called dysphagia
• Weight loss
• Fatigue, or difficulty or pain with breathing associated with anemia

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. In order to diagnose Barrett esophagus, your doctor may recommend an upper GI endoscopy with a biopsy.

Treatment

The cell changes from Barrett esophagus are permanent once they occur. Talk to your doctor about the best treatment options for you. Treatment may include:

Medications

Your doctor may recommend the proton pump inhibitors (PPIs). PPIs help control GERD symptoms and prevent further damage to the esophagus.

Surgery

Your doctor may recommend surgery if the disease is severe or the medication is not helpful. Surgical options may include:

Fundoplication

A part of the upper stomach is wrapped around the esophagus. This is done to reduce further damage caused by GERD.

Endoscopic Eradication

Endoscopic eradication destroys the Barrett cells in the esophagus. Eventually, the body starts making normal esophageal cells where the Barrett cells used to be. The most common endoscopic eradication procedures include:

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

Esophagectomy

This procedure removes the part of the esophagus that has the Barrett. The esophagus reconstructed using a part of the stomach or large intestine.

Monitoring

Your doctor may recommend endoscopy from every 3 months-5 years depending on how abnormal the cells in your esophagus look.

Prevention

The best way to prevent Barrett esophagus is to reduce or treat the reflux of stomach acid into the esophagus. This is usually caused by GERD. Self-care measures for GERD include:

• Not smoking. If you smoke, talk to your doctor about how to successfully quit.
• Losing excess weight.
• Raising the head of your bed onto 4-6 inch blocks.
• Avoid ingclothes with tight belts or waistbands.
• Avoiding foods that cause heartburn. These include alcohol, caffeinated beverages, chocolate, and foods that are fatty. This also includes spicy or acidic foods such as citrus or tomatoes.
• Not eating or drinking for 3-4 hours before you lie down or go to bed.

If you have GERD and are at a high risk for Barrett esophagus, talk to your doctor about a screening schedule.