Barrett’s esophagus is a condition of the lower end of the esophagus where intestinal cells have replaced esophageal cells usually after years of experiencing acid reflux or GERD (gastroesophageal reflux disease). When stomach acids splash up into the esophagus, they irritate the lining of the esophagus causing pain or a burning sensation in the chest or throat. This irritation is caused by the malfunction of the lower esophageal sphincter muscle which fails to keep the contents of the stomach contained. Although some people develop Barrett’s esophagus without having GERD, acid reflux is considered a risk factor for the condition. Yet it is a condition that may be averted if you suffer with GERD and take steps to reduce acid reflux. It is estimated that 10 percent to 20 percent of Americans suffer with acid reflux every day, but only one percent of Americans develop the esophageal condition. It has been linked with a rare form of cancer which is quite aggressive. Barrett’s esophagus is primarily diagnosed after the age of fifty, and it affects twice as many men as women, and very few cases reported in children. Caucasian and Hispanic men have a higher risk factor for developing the condition.
Diagnosis of Barrett’s Esophagus
Barrett’s esophagus is without signs and symptoms, and it can only be diagnosed through an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. In the procedure with the patient sedated, an endoscope (a flexible tube) is inserted into the esophagus. The endoscope has a light and a small camera which will show the interior of the esophagus on a monitor. The doctor can remove several small tissue samples from the esophagus with a pincherlike device that comes through the endoscope. The average age at diagnosis is fifty, but the condition may have been present for a while before diagnosis. If you have had GERD for a number of years and are over the age of forty, your doctor will probably want to check your esophagus periodically to make sure the condition is not developing.
Post Diagnosis of Barrett’s Esophagus
Once the diagnosis is made of Barrett’s esophagus, your doctor will want to check your esophagus for cellular changes on a regular basis. Before esophageal cancer develops, usually, there will be changes in the type of cells lining the esophagus. Dysplasia is the term used for these precancerous cells which are a precursor to cancer. These periodic endoscopic examinations will be important to access any changes in cell composition. Also, it should be noted that the risk is low for esophageal cancer with only one percent of people who have Barrett’s esophagus developing this cancer.
Barrett’s Esophagus Treatment
Dysplasia and Esophageal Cancer
Severe dysplasia and esophageal cancer can be treated with endoscopic therapies or surgery where the lining of the esophagus is destroyed or cut to remove the affected part. The procedures are done in the hope that normal tissue will replace the diseased tissue, and are performed by doctors who specialize in these.
- Endoscopic mucosal resection (EMR) removes the Barrett’s lining by injecting a solution under it or applying suction to it, and then the lining is cut and removed through the endoscope. In treating cancer, an endoscopic ultrasound is done to make sure only the top layer of esophageal cells is removed.
- Photodynamic therapy (PDT) uses a laser and a light-sensitizing agent (Photofrin) to destroy dysplastic and cancerous cells. The light-sensitizing agent is injected into a vein 48 hours before the procedure. During the PDT, the laser light coming through the endoscope activates the Photofrin to destroy the abnormal tissue in the esophagus.
- Surgery to remove most of the esophagus with severe dysplasia or cancer is advised for patients who can tolerate a surgical procedure. Surgery offers the best chance for a cure, but many elderly people are not healthy enough for surgery and less invasive methods are often recommended in their cases.
Barrett’s esophagus results from the transformation of esophageal cells into intestinal cells in the lining of the esophagus. People who suffer from GERD are believed to be at a higher risk for developing the condition. If the symptoms of GERD can be reduced with acid controlling medications, it may reduce the chances of Barrett’s esophagus occurring. Close surveillance of the condition with endoscopic examinations is recommended to access cellular changes which can lead to cancer. For those who have severe dysplasia or cancer, there are several endoscopic procedures available to remove affected tissue. Research is ongoing in diagnosing and improving endoscopic procedures to correct Barrett’s esophagus.
written by Joy Seeman
© 2009 Hemorrhoid Information Center
Sources:
Anand, M.D., Bhupinder, & Weinstein, M.D., Wilfred M. (n.d.). Barrett’s Esophagus. Retrieved August 27, 2009, from MedicineNet.com: http://www.medicinenet.com
Barrett’s Esophagus. (2008, July). Retrieved August 27, 2009, from National Digestive Diseases Information Clearinghouse: http://digestive.niddk.nih.gov
Barrett’s Esophagus. (2009, August 14). Retrieved August 27, 2009, from Mayo Clinic: http://www.mayoclinic.com
