Barrett's esophagus
Definition:
Barrett's esophagus is a condition in which the cells of your lower esophagus become damaged, usually from repeated exposure to stomach acid. The damage causes changes to the color and composition of the esophagus cells.
Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.
A diagnosis of Barrett's esophagus can be concerning because it increases the risk of developing esophageal cancer. Although the risk of esophageal cancer is small, monitoring of Barrett's esophagus focuses on periodic exams to find precancerous esophagus cells. If precancerous cells are discovered, they can be treated to prevent esophageal cancer.
Symptoms:
Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:
When to see a doctor
If you've had long-term trouble with heartburn and acid reflux, discuss this with your doctor and ask about your risk of Barrett's esophagus.
Seek immediate medical attention if you:
Causes:
The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.
Still, some people diagnosed with Barrett's esophagus have never experienced heartburn or acid reflux. It's not clear what causes Barrett's esophagus in these cases.
Complications:
Increased risk of esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal cancer. Still, the risk is small, especially in people whose lab test results show no precancerous changes (dysplasia) in their esophagus cells. The overwhelming majority of people with Barrett's esophagus will never develop esophageal cancer.
Studies of people with Barrett's esophagus show most think their risk of esophageal cancer is much higher than it really is. This causes needless worry and anxiety.
If you're worried about your risk of esophageal cancer, ask your doctor to explain your chances of developing the disease. Also ask what you can do to reduce your risk. This may help you feel more in control of your health.
Treatments and drugs:
Your treatment options for Barrett's esophagus depend on whether high-grade or low-grade dysplasia is found in the cells of your esophagus, your overall health and your own preferences.
Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:
High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:
Definition:
Barrett's esophagus is a condition in which the cells of your lower esophagus become damaged, usually from repeated exposure to stomach acid. The damage causes changes to the color and composition of the esophagus cells.
Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.
A diagnosis of Barrett's esophagus can be concerning because it increases the risk of developing esophageal cancer. Although the risk of esophageal cancer is small, monitoring of Barrett's esophagus focuses on periodic exams to find precancerous esophagus cells. If precancerous cells are discovered, they can be treated to prevent esophageal cancer.
Symptoms:
Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:
- Frequent heartburn
- Difficulty swallowing food
- Chest pain
- Upper abdominal pain
- Dry cough
When to see a doctor
If you've had long-term trouble with heartburn and acid reflux, discuss this with your doctor and ask about your risk of Barrett's esophagus.
Seek immediate medical attention if you:
- Have chest pain
- Have difficulty swallowing
- Are vomiting red blood or blood that looks like coffee grounds
- Are passing black, tarry or bloody stools
Causes:
The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.
Still, some people diagnosed with Barrett's esophagus have never experienced heartburn or acid reflux. It's not clear what causes Barrett's esophagus in these cases.
Complications:
Increased risk of esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal cancer. Still, the risk is small, especially in people whose lab test results show no precancerous changes (dysplasia) in their esophagus cells. The overwhelming majority of people with Barrett's esophagus will never develop esophageal cancer.
Studies of people with Barrett's esophagus show most think their risk of esophageal cancer is much higher than it really is. This causes needless worry and anxiety.
If you're worried about your risk of esophageal cancer, ask your doctor to explain your chances of developing the disease. Also ask what you can do to reduce your risk. This may help you feel more in control of your health.
Treatments and drugs:
Your treatment options for Barrett's esophagus depend on whether high-grade or low-grade dysplasia is found in the cells of your esophagus, your overall health and your own preferences.
Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:
-
Periodic endoscopy exams to monitor the cells in your esophagus.
How often you undergo endoscopy exams will depend on your situation.
Typically, if your biopsies show no dysplasia, you'll have a follow-up
endoscopy one year later. If your doctor again detects no dysplasia,
your doctor will likely recommend endoscopy exams every three years. If
low-grade dysplasia is detected, your doctor may recommend GERD
treatments and another endoscopy in six months or a year. If you're
determined to have high-grade dysplasia, then your doctor may offer
other treatment options.
Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.
- Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find prescription medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. One such procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.
High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:
- Surgery to remove the esophagus. During an
esophagectomy, the surgeon removes most of your esophagus and attaches
your stomach to the remaining portion. Surgery carries a risk of
significant complications, such as bleeding, infection and leaking from
the area where the esophagus and stomach are joined. When esophagectomy
is performed by an experienced surgeon, there's a reduced risk of
complications. Still, because of the potential complications of this
major operation, other treatments are usually preferred over surgery.
One advantage to surgery is that it reduces the need for periodic
endoscopy exams in the future.
- Removing damaged cells with an endoscope.
Endoscopic mucosal resection is used to remove areas of damaged cells
using an endoscope. Your doctor guides the endoscope down your throat
and into your esophagus. Special surgical tools are passed through the
tube. The tools allow your doctor to cut away the superficial layers of
the esophagus and remove damaged cells. Endoscopic mucosal resection
carries a risk of complications, such as bleeding, rupture and narrowing
of the esophagus.
- Using heat to remove abnormal esophageal tissue.
Radiofrequency ablation involves inserting a balloon filled with
electrodes in the esophagus. The balloon emits a short burst of energy
that destroys the damaged esophageal tissue. Radiofrequency ablation
carries a risk of narrowing of the esophagus, bleeding and chest pain.
- Using cold to destroy abnormal esophagus cells.
Cryotherapy involves using an endoscope to apply a cold liquid or gas to
the abnormal cells in the esophagus. The cells are allowed to warm up
and then are frozen again. The cycle of freezing and thawing damages the
cells. Cryotherapy carries a risk of chest pain, narrowing of the
esophagus and tearing of the esophagus.
- Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain and nausea.
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