Dr. Ertan Beyatlı

What is Barrett's Esophagus?

(Update: ) - Digestive System Diseases

In Barrett's esophagus, the normal tissue lining the esophagus transforms into tissue that resembles the intestinal lining. This condition is a serious complication of gastroesophageal reflux disease (GERD). About 10% of people with chronic GERD symptoms develop Barrett's.

Barrett's esophagus has no specific symptoms, although patients with Barrett's esophagus may have symptoms associated with GERD (GERD). However, it increases the risk of developing esophageal adenocarcinoma (Esophageal CA), a serious, potentially fatal cancer of the esophagus.

Although those with Barrett's esophagus have a higher risk of this cancer, Barrett's esophagus rarely develops into cancer. Less than 1% of people with Barrett's esophagus develop this particular cancer. Still, if you've been diagnosed with Barrett's esophagus, it's important to have a routine examination of your esophagus. With a routine examination, your doctor can discover pre-cancerous and cancer cells early, before they spread, and when the disease is easier to treat.

GERD and Barrett's Esophagus relationship

People with GERD may experience symptoms such as heartburn, heartburn in the back of the throat, burning sensation, chronic cough, laryngitis, and nausea. (see: Les Looseness and GERD)

When you swallow food or liquids, it automatically passes through the esophagus, a hollow, muscular tube that flows from your throat to your stomach. A ring of muscle (esophageal sphincter, LES, LES) at the lower end of the esophagus prevents stomach contents from returning to the esophagus.

The stomach produces acid to digest food, but it is also protected from the acid it produces. In the case of GERD, stomach contents flow back into the esophagus. This is known as reflux.

In fact, most people with acid reflux do not develop Barrett's esophagus.

But in patients with frequent acid reflux, normal cells in the esophagus may eventually be replaced by cells that resemble cells in the gut to become Barrett's esophagus.

Does GERD always cause Barrett's Esophagus?

No. Barrett's esophagus does NOT develop in every patient with GERD. At the same time, it cannot be said that every patient with Barrett's esophagus also has GERD. But long-term GERD is the primary risk factor.

Anyone can develop Barrett's esophagus, but white men with prolonged GERD are more likely than others. Other risk factors include the onset of GERD at a young age and a current or past smoking history.

How Is Barrett's Esophagus Diagnosed?

Since there are no specific findings associated with Barrett's esophagus, only an upper digestive endoscopy ve biopsy can be diagnosed with.

American Gastroenterological Association (AGA) guidelines recommend screening people with multiple risk factors for Barrett's esophagus. So what are these RISK FACTORS:

  • Over 50
  • male gender
  • the white race
  • hiatal hernia (stomach hernia)
  • prolonged GERD
  • Obesity

For detailed information about how to do endoscopy, you can take a look at the article I wrote earlier: How is Stun Endoscopy performed?

After the endoscope is inserted, the doctor can visually examine the lining of the esophagus. Barrett's esophagus, if present, can be seen on camera, but definitive diagnosis requires a biopsy. The doctor will remove a small tissue sample that will be examined under a microscope in the lab to confirm the diagnosis. The sample will also be examined for the presence of precancerous cells or cancer.

Barret's esophagus and normal esophagus seen during gastroscopy.

If the biopsy confirms the presence of Barrett's esophagus, your doctor will likely recommend a follow-up endoscopy and biopsy for further tissue examination for early signs of cancer development.

If you have Barrett's esophagus but no cancer or precancerous cells are found, your doctor will likely still recommend that you have periodic repeat endoscopy. This is a precaution because cancer may develop in Barrett's tissue years after the diagnosis of Barrett's esophagus. If precancerous cells are present in the biopsy, your doctor will discuss treatment and monitoring options with you.

Can Barrett's Esophagus Be Treated?

One of the most important goals of treatment is to prevent or slow down Barrett's esophagus development by treating and controlling acid reflux. This is done with lifestyle changes and medications.

Lifestyle changes

Lifestyle changes involve taking steps such as:

  • Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can increase reflux.
  • Avoid alcohol, caffeinated drinks, and tobacco.
  • Lose weight. Being overweight increases the risk of reflux.
  • Sleep with the head of the bed raised. Lying with your head up (15-20cm) can help prevent acid in your stomach from flowing into the esophagus.
  • Do not lie down for 3 hours after eating.
  • Take all medicines with plenty of water.
High pillow lying position for Barrett's Esophagus
High pillow lying position for Barrett's Esophagus

Medicines

Your doctor may also prescribe medications to help. These medications can include:

  • Proton pump inhibitors that reduce stomach acid production
  • Antacids to neutralize stomach acid
  • H2 blockers that reduce stomach acid release
  • Promoting agents - drugs that speed up the passage of food from the stomach to the intestines (drugs that facilitate digestion)

Special Options for Barrett's Esophagus

There are a variety of treatments available, including specifically researched surgical methods to focus on abnormal tissue. These:

  • Radiofrequency ablation (RFA)uses radio waves through an endoscope inserted into the esophagus to destroy abnormal cells while protecting the healthy cells beneath them.
  • Photodynamic therapy (PDT)uses a laser from the endoscope to kill abnormal cells in the lining without damaging normal tissue. Before the procedure, the patient takes a drug known as Photofrin, which causes the cells to become photosensitive.
  • Endoscopic spray cryotherapyCold nitrogen or carbon dioxide gas is applied through the endoscope to freeze the abnormal cells.
  • Endoscopic mucosal resection (EMR)The abnormal tissue is cut from the esophagus through the endoscope. The aim is to remove pre-cancerous or cancerous cells in the lining. If there are cancer cells, an ultrasound is done first to make sure the cancer does not go deeper into the esophageal walls.
  • Removing most of the esophagus surgery for severe precancerous (dysplasia) or is an option when diagnosed with cancer. The sooner the surgery is performed after diagnosis, the better the chance of treatment.

There are a few facts to keep in mind:

  • GERD is common among adults.
  • Only a small percentage of people with GERD (less than 10 in XNUMX people) develop Barrett's esophagus.
  • Less than 1% of those with Barrett's esophagus continue to develop esophageal cancer each year.

The diagnosis of Barrett's esophagus is not too bad (not a major cause for alarm). But Barrett's esophagus can cause precancerous changes in a small number of people, leading to an increased risk for cancer. For this reason, we recommend that you keep in close contact with your doctor when the diagnosis is made.

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