What is Barrett's Esophagus
Barrett’s esophagus is a precancerous condition of the esophagus, often associated with heartburn and gastro-esophageal reflux disease. One to two percent of the adult American population potentially has this pre-malignant condition. Because up to 0.5% of people with Barrett’s will go on to develop esophageal cancer, frequent surveillance is very important. Cancer of the lower esophagus is rapidly increasing, especially in white males.
What Causes Barrett’s Esophagus?
Chronic reflux of stomach acid up into the esophagus can harm the delicate lining of the esophagus. The stomach has a special lining to protect itself from the strong acids that are produced to help digest your food. However, your esophagus does not have this same protective lining and can be easily damaged by chronic acid reflux. Instead there is a one way “valve” (lower esophageal sphincter) at the base of your esophagus that prevents the backflow of acid into the esophagus. If the valve gets weak, acid is allowed back in to the esophagus which can cause erosions; this is known as gastro-esophageal reflux disease. If gastro-esophageal reflux disease (G.E.R.D.) is left untreated, over time the lining of the esophagus changes. The new lining, which develops as a self protective mechanism, more closely resembles the lining of the small intestine and is known as “intestinal metaplasia.” This may explain why the symptoms of reflux disease seem to lessen in some patients with Barrett’s esophagus. Over a period of years the intestinal metaplasia may develop abnormal cell changes, called dysplasia (classified as low grade or high grade dysplasia), which can eventually progress to cancer.
The condition of Barrett’s esophagus does not have any symptoms itself. Most patients have symptoms associated with Gastro-esophageal Reflux disease and chronic heartburn. Some people may experience difficulty swallowing food, have a persistent unexplained cough or a hoarse voice. Unfortunately, some patients do not have any symptoms at all, thus they may not even know they have the condition.
The diagnosis of Barrett’s esophagus requires an upper endoscopy to allow your doctor to directly visualize the lining of the esophagus. Your doctor will take biopsies to confirm the presence of Barrett’s and to ensure that it has not progressed to dysplasia.
The primary goal of treatment is to stop acid reflux thus preventing any further damage from occurring. There is no cure for Barrett’s esophagus. Even if the symptoms are well controlled, there is still a risk of cancer; that is why it is imperative that regular endoscopic exams (usually every one to two years) are performed.
Your doctor will most likely prescribe medication (Prilosec, Prevacid, Aciphex, Nexium, Protonix) to effectively reduce the secretion of stomach acid, thereby reducing acid reflux. Short-term use of these medications is very safe; the effects of long term use are not yet known.
Some general guidelines for treating the symptoms of heartburn and acid reflux are:
- Avoid foods and substances that increase reflux of acid into the esophagus, such as:
- Nicotine (cigarettes)
- Fatty foods
- Peppermint and spearmint
- Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime or lying down.
- Avoid bending, stooping, tight belts, and girdles, all of which increase abdominal pressure and cause reflux.
- If overweight, lose weight. Obesity increases abdominal pressure.
- Certain medications, such as intestinal anti-spasmodics, calcium channel blockers, and some anti-depressants weaken the lower esophageal sphincter muscle.
- Elevate the head of your bed 8 to 10 inches by putting a wedge under the upper part of the mattress or placing blocks under the head of the bed. Gravity then helps keep stomach acid out of the esophagus while sleeping.
Surgery to simply control reflux can now be accomplished laparoscopically, which greatly reduces hospital stay and recovery times, making surgery a more viable option for many. This surgery does not remove or cure the Barrett’s esophagus; it will, however, prevent further damage. This is an option for patients that do not yet have dysplasia and that have not responded well to acid blocking medications. If the Barrett’s has progressed to a further stage it may be necessary to actually remove part of the esophagus. This is a much bigger surgery but it will completely remove the Barrett’s tissue.
There are several new modalities on the horizon in the treatment of Barrett’s esophagus. Many of these can be accomplished endoscopically, but their long-term efficacy has not yet been determined.