Barrett's Esophagus
Barrett’s esophagus is a condition in which the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia. Barrett’s esophagus affects about one percent of adults in the United States. The exact causes of Barrett’s esophagus are
unknown, but gastroesophageal reflux disease (GERD) is a risk factor for the condition. Although people who do not have GERD can have Barrett’s esophagus, the condition is found about three-to-five times more often in people who also have GERD.
Common Symptoms
No signs or symptoms are typically associated directly with Barrett’s esophagus, but symptoms of GERD may be present. GERD is a more serious form of gastroesophageal reflux (GER). GER occurs when the lower esophageal sphincter opens spontaneously or does not close properly and stomach contents rise into the esophagus. GER is also commonly known as acid reflux. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Persistent reflux that occurs more than twice a week is considered GERD and can eventually lead to more serious health problems.
Most physicians recommend treating GERD symptoms with acid-reducing agents called antacids such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids. Other drugs used to relieve GERD symptoms are antisecretory drugs, such as H2 blockers and proton pump inhibitors (PPIs). Improvement in GERD symptoms may lower the risk of developing Barrett’s esophagus. A surgical procedure may be recommended if medications are not effective in treating GERD.
Diagnosis
Barrett’s esophagus can only be diagnosed by using an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. If the tissue appears suspicious, the doctor removes several small pieces of tissue (biopsies) using a pincher-like device that is passed through the endoscope. These tissue samples are then microscopically examined by a pathologist - a physician who specializes in the diagnosis of disease via microscopic examination of a tissue sample. The pathologist's diagnosis is often the key to determining the need for further treatment.
Treatment Options
Endoscopic or surgical treatments are available to treat severe dysplasia and cancer. During these therapies, the Barrett’s lining is destroyed or the portion of the lining that has dysplasia or cancer is cut out. The goal of the treatment is to encourage normal esophageal tissue to replace the destroyed Barrett’s lining. Endoscopic therapies are performed at specialty centers by physicians with expertise in
the following procedures:
• Photodynamic therapy (PDT). PDT uses a light-sensitizing agent called “Photofrin” and a laser
to kill precancerous and cancerous cells. Photofrin is injected into a vein, and the patient returns
in 48 hours. The laser light is then passed through the endoscope and activates the Photofrin
to destroy Barrett’s tissue in the esophagus.
• Endoscopic Mucusal Resection (EMR). EMR involves lifting the Barrett’s lining and injecting
a solution under it or applying suction to it and then cutting it off. The lining is then removed
through the endoscope. If EMR is used to treat cancer, an endoscopic ultrasound is first done
to make sure the cancer involves only the top layer of esophageal cells.
• Surgery. Surgical removal of most of the esophagus is recommended if a person with Barrett’s
esophagus is found to have severe dysplasia or cancer and can tolerate a surgical procedure.
Surgery soon after diagnosis of severe dysplasia or cancer may provide a person with the
best chance of a cure.
Periodic endoscopic examinations with biopsies to look for early warning signs of cancer are generally recommended for people who have Barrett’s esophagus. This approach is called “surveillance.” Typically, before esophageal cancer develops, precancerous cells appear in the Barrett’s tissue. This condition is called “dysplasia” and can be seen only through biopsies.
Questions To Ask Your Healthcare Provider
• What treat option is best for me?
• What are the potential side effects?
• What are my risks?
• What dietary or lifestyle changes do you recommend?
This information is provided by Aurora Diagnostics. It is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon your medical history and current condition. Only your physician and you can determine your best option.