Barrett’s Esophagus

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Barrett’s esophagus is a complication of gastroesophageal reflux disease, or GERD, that – while uncommon – could develop into something serious. It is caused by chronic reflux, when stomach acids and other contents back up into the esophagus, the tube that carries food from the mouth to the stomach. In some patients, the cells that line the esophagus transform into tissue that resembles the lining of the stomach.

This abnormality, which occurs in nearly 10% of patients with chronic GERD, can increase the risk of forming a type of cancer called esophageal adenocarcinoma.

A key issue of Barrett’s esophagus is that it displays no symptoms, other than those related to GERD. Yet due to the small yet serious risk of Barrett’s esophagus developing into cancer, it is essential that those with risk factors be tested.

Because Barrett’s esophagus does not present symptoms one could feel, patients with the condition may experience signs related to GERD. These signs include:

  • Heartburn
  • Regurgitation of stomach contents
  • A sour, burning sensation at the back of the throat
  • Chronic cough
  • Laryngitis
  • Nausea
  • Difficulty swallowing food

Risk factors for Barrett’s include having a family history or Barrett’s or esophageal cancer, Caucasian race, male sex, increasing age, chronic heartburn, history of smoking, and being overweight.

Typically, Barrett’s esophagus is detected on an upper endoscopy. During this procedure, the physician inserts a flexible tube (endoscope) with a tiny camera into the esophagus. The doctor looks for abnormalities in the lining of the esophagus, stomach, and duodenum (start of the small intestine). Barrett’s esophagus is visible on camera, but the diagnosis requires a biopsy.

A biopsy examines a small sample of tissue under a microscope for the presence of precancerous or cancerous cells. The sample can be taken during the upper endoscopy.

Treating or slowing the development of Barrett’s esophagus requires controlling acid reflux. Many lifestyle changes and medication can accomplish this, including:

  • Diet change to minimize fatty foods, chocolate, caffeine, spicy foods, alcohol, and peppermint
  • Avoiding tobacco
  • Losing weight
  • Not lying down for three hours after eating, and sleeping with a raised head
  • Controlling acid with medications
  • Barrett’s esophagus also requires monitoring to prevent the development of cancer. If the patient has dysplasia or abnormal cells of the Barrett’s discovered on endoscopy, several treatment options are available.

Physician-applied treatments can include:

  • Radiofrequency ablation (RFA): Radio waves are delivered through an endoscope in the esophagus to destroy abnormal cells.
  • Endoscopic spray cryotherapy: Freezing abnormal cells by applying cold nitrogen or carbon dioxide gas through the endoscope.
  • Endoscopic mucosal resection (EMR): Cutting the abnormal lining away from the esophagus before removing it through the endoscope.

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