What is Barrett’s esophagus
Barrett’s esophagus is a condition in which the cells that make up your esophagus begin to look like the cells that make up your intestines. This often happens when cells are damaged by exposure to acid from the stomach.
This condition often develops after years of experiencing gastroesophageal reflux (GERD). In some cases, Barrett’s esophagus can develop into esophageal cancer.
What causes Barrett’s esophagus
The exact cause of Barrett’s esophagus is not yet known. However, the condition is most often seen in people with GERD.
GERD occurs when the muscles at the bottom of the esophagus do not work properly. The weakened muscles won’t prevent food and acid from coming back up into the esophagus.
It’s believed that the cells in the esophagus can become abnormal with long-term exposure to stomach acid. Barrett’s esophagus can develop without GERD, but patients with GERD are 3 to 5 times more likely to develop Barrett’s esophagus.
Approximately 5 to 10 percent of people with GERD develop Barrett’s esophagus. It affects men almost twice as often as women and is usually diagnosed after the age of 55.
Over time, the cells of the esophageal lining may develop into precancerous cells. These cells may then change into cancerous cells. However, having Barrett’s esophagus doesn’t mean you will get cancer.
It’s estimated that only about 0.5 percent of people with Barrett’s esophagus develop cancer.
What are the risk factors?
If you have GERD symptoms for longer than 10 years, you have an increased risk of developing Barrett’s esophagus.
Other risk factors for developing Barrett’s esophagus include:
- being male
- being Caucasian
- being over the age of 50
- having H pylori gastritis
- being obese
Factors that aggravate GERD can worsen Barrett’s esophagus. These include:
- frequent use of NSAIDS or Aspirin
- eating large portions at meals
- diets high in saturated fats
- spicy foods
- going to bed or lying down less than four hours after eating
Recognizing the symptoms of Barrett’s esophagus
Barrett’s esophagus does not have any symptoms. However, because most people with this condition also have GERD, they will usually experience frequent heartburn.
Call your doctor right away if any of the following symptoms occur:
- having chest pain
- vomiting blood, or vomit that resembles coffee grounds
- having difficulty swallowing
- passing black, tarry, or bloody stools
Diagnosing and classifying Barrett’s esophagus
If your doctor suspects 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. An endoscope allows your doctor to see the inside of your esophagus.
Your doctor will be checking to make sure that your esophagus looks pink and shiny. People who have Barrett’s esophagus often have an esophagus that looks red and velvety.
Your doctor may also take a tissue sample that will allow them to understand what changes are going on in your esophagus. Your doctor will examine the tissue sample for dysplasia, or the development of abnormal cells. The tissue sample 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
Treatment options for Barrett’s esophagus
Treatment for Barrett’s esophagus depends on what level of dysplasia your doctor determines you have. Options may include:
No or low-grade dysplasia
If you have no or low-grade dysplasia, your doctor will likely recommend treatments that will help you manage your GERD symptoms. Medications to treat GERD include H2-receptor antagonists and proton pump inhibitors.
You may also be a candidate for surgeries that can help you manage your GERD symptoms. There are two surgeries that are commonly performed on people with GERD, which include:
This surgery attempts to strengthen the lower esophageal sphincter (LES) by wrapping the top of your stomach around the outside of the LES.
In this procedure, your doctor will insert the LINX device around lower esophagus. The LINX device is made up of tiny metal beads that use magnetic attraction to keep the contents of your stomach from leaking into your esophagus.
A doctor performs the Stretta procedure with an endoscope. Radio waves are used to cause changes in the muscles of the esophagus near where it joins the stomach. The technique strengthens the muscles and decreases reflux of the stomach contents.
High grade dysplasia
Your doctor may recommend more invasive procedures if you 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:
This procedure uses an endoscope with a special attachment that emits heat. The heat kills abnormal cells.
In this procedure, an endoscope dispenses cold gas or liquid that freeze the abnormal cells. The cells are allowed to thaw, and then are frozen again. This process is repeated until the cells die.
Your doctor will inject you with a light-sensitive chemical called porfimer (Photofrin). An endoscopy will be scheduled 24 to 72 hours after the injection. During the endoscopy, a laser will activate the chemical and kill the abnormal cells.
Possible complications for all of these procedures may include chest pain, narrowing of the esophagus, cuts in your esophagus, or rupture of your esophagus.
What is the outlook for Barrett’s esophagus?
Barrett’s esophagus raises your risk for developing esophageal cancer. However, many people with this condition never develop cancer. If you have GERD, talk with your doctor to find a treatment plan that will help you manage your symptoms.
Your plan may include making lifestyle changes such as quitting smoking, limiting alcohol consumption, and avoiding spicy foods. You may also start eating smaller meals low in saturated fats, waiting at least 4 hours after eating to lie down, and elevating the head of your bed.
All of these measures will decrease gastroesophageal reflux. You also may be prescribed H2-receptor antagonists or proton pump inhibitors.
It’s also important to schedule frequent follow-up appointments with your doctor so they can monitor the lining of your esophagus. This will make it more likely that your doctor will discover cancerous cells in the early stages.