Barrett’s Esophagus: Symptoms, Treatment

Overview

Barrett’s esophagus is a condition in which the cells that make up the esophagus begin to look like the cells that make up the intestines. In Barrett’s esophagus, the normal cells that line the esophagus called squamous cells turn into a type of cell called specialized columnar cells with intestinal metaplasia. This often happens when cells are damaged by exposure to acid from the stomach.

It is a serious complication of gastroesophageal reflux disease (GERD). About 10% of people with chronic symptoms of GERD develop Barrett’s esophagus. Barrett’s esophagus is associated with an increased risk of developing esophageal cancer. It can occur at any age but is more common in older adults.

Causes

What
exactly causes Barrett’s esophagus is not yet known. In most cases, the
condition is most often seen in people with GERD.

In
GERD, stomach contents wash back into the esophagus and damage the esophagus
tissue. When the esophagus tries to heal itself, the cells can change to the
type of cells found in Barrett’s esophagus. GERD occurs when the muscles
at the bottom of the esophagus do not work properly. The weakened muscles cannot
prevent food and acid from coming back up into the esophagus. The cells in the
esophagus can become abnormal with long-term exposure to stomach acid. Although
Barrett’s esophagus can develop without GERD, patients with GERD are 3 to 5
times more likely to develop Barrett’s esophagus.

It
affects men almost twice as often as women and occurs usually after the age of
55. It’s estimated that only about 0.5 percent of people with Barrett’s
esophagus develop cancer.

There
are some factors that increase the risk of Barrett’s esophagus:

  • Chronic heartburn and acid reflux
  • Age
  • Gender
  • Obesity
  • Having H. pylori gastritis
  • Smoking
  • Use of alcohol
  • Frequent use of NSAIDS or aspirin
  • Unbalanced diet

Symptoms

In
general, Barrett’s esophagus does not cause any symptoms. The signs and
symptoms that people may experience are commonly due to GERD, which include:

  • Frequent heartburn
  • Difficulty with swallowing food
  • Chest pain
  • Passing black, tarry, or bloody stools
  • Vomiting blood

Diagnosis

If the
doctors suspect that you have Barrett’s esophagus, they may order an endoscopy.
An endoscopy is a procedure that uses an endoscope, or a tube with a small
camera and light on it. By using an endoscope, it allows the doctor to see the
inside of the esophagus. Besides, a biopsy is also used to see whether the
normal squamous cells have been replaced with Barrett’s cells.

The doctor may also take a tissue sample that will allow him/her to understand what changes are going on in the esophagus. The doctor will examine the tissue sample for dysplasia, or the development of abnormal cells. The tissue sample will be ranked based on the following degrees of change:

  • no dysplasia: no visible cell abnormalities

  • low grade dysplasia: small amount of cell abnormalities

  • high grade dysplasia: large amount of cell abnormalities and cells that may become cancerous

If the patient has Barrett’s esophagus but no cancer or precancerous cells are found, the doctor may recommend taking periodic repeat endoscopy. This works as a precaution, because cancer can develop in Barrett tissue years after diagnosis of Barrett’s esophagus. If precancerous cells are seen in the biopsy, the doctor will discuss treatment options with the patient.

Treatment

Treatment
for Barrett’s esophagus depends on the level of dysplasia in your esophagus and
your overall health.

No dysplasia

The
doctor will likely recommend:

  • Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you’ll probably have a follow-up endoscopy in one year and then every three years if no changes occur.

  • Medication and lifestyle changes for easing your signs and symptoms.

  • Surgery to tighten the sphincter that controls the flow of stomach acid.

Low-grade dysplasia

For low-grade dysplasia, the doctor may recommend another endoscopy in six months, with additional follow-ups every 6 to 12 months. However, considering the risk of esophageal cancer, the doctor may recommend the following treatments:

  • Endoscopic resection, which uses an endoscope to remove damaged cells.

  • Radiofrequency ablation, which uses an endoscope with a special attachment that emits heat to remove abnormal esophagus tissue. Radiofrequency ablation is taken after endoscopic resection.

High-grade dysplasia

The
doctor may recommend more invasive procedures if the patient have high-grade
dysplasia. For example, removing damaged areas of the esophagus through the use
of endoscopy. In some cases, entire portions of the esophagus are removed.
Other treatments include:

  • Cryotherapy. In this procedure, it uses an endoscope to apply cold gas or liquid to abnormal cells in the esophagus. The cells can warm up, and then are frozen again. This process is often repeated until the cells die.

  • Photodynamic therapy. The doctor will inject a patient with a light-sensitive chemical called porfimer. It destroys abnormal cells by making them sensitive to light.

  • Surgery to remove the damaged part of your esophagus. However, it is possible for Barrett’s esophagus to recur after treatment.

Keywords: Barrett’s esophagus.

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