Barrett’s Esophagus

Barrett’s esophagus is a disorder treated by the GI Division at Premier Medical Group.

What is Barrett’s esophagus?

Barrett’s esophagus is a disorder in which the lining of the esophagus (the tube that carries food from the throat to the stomach) is damaged by stomach acid and changed to a lining similar to that of the stomach. Barrett’s esophagus affects about one percent of people in the United States, is more common in men than women, and in people who have chronic GERD. Generally diagnosis is not made before the age of 50; Caucasian men are more likely to be affected than men of other races. Barrett’s esophagus is uncommon in children.

What causes Barrett’s esophagus?

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When you eat, food passes through the throat, and esophagus (or food pipe) into your stomach. When the food reaches your stomach, muscles tighten to keep the food from going back into the esophagus.  If these muscles fail to close tightly, stomach acid can leak back into the esophagus.  This is reflux disease (link) or gastroesophageal reflux. In Barrett’s esophagus, the lining of the “food tube” or esophagus is replaced by a lining or tissue that is comparable to the lining of the intestines. (metaplasia) A small percentage of people with chronic GERD, develop Barrett’s esophagus.

What are the symptoms of Barrett’s esophagus?

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Barrett’s esophagus does not show precise symptoms, but if the patient has Reflux disease, heartburn (link) may occur. Some patients report feeling their esophagus when they swallow something too large, eat too quickly, or drink very hot or very cold beverages.  Barrett’s esophagus can also lead to a more serious problem called dysplasia. When dysplasia is present, the risk of getting cancer of the esophagus increases.

How is Barrett’s esophagus diagnosed?

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Barrett’s esophagus can only accurately be diagnosed using an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. The doctor will sedate you, insert a flexible tube called an endoscope, which has a light and a miniature camera, into the esophagus, and if the ling of the esophagus looks abnormal, he may take a sample of the tissue and send it to a pathologist to be analyzed. Because Barrett’s esophagus causes no symptoms, physicians often recommend an endoscopy to patients over 40 who have suffered from GERD for many years.  Although a diagnosis of Barrett’s esophagus considered a precancerous state, it is not a cause for major alarm. Work with your doctor on the right treatment for you and be watchful of your health.

 

How is Barrett’s esophagus treated?

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The two most common treatments for Barrett’s Esophagus are surgery or endoscopic treatments. Your doctor will decide on the exact treatment based on the age of the patient and severity of the disease.

Surgery

The type of surgery differs, but generally involves the removal of most of the esophagus, and a portion of the stomach is pulled up to the chest and attached to the remaining esophagus. If the patient is found to have cancer or serious dysplasia, then surgical removal of most of the esophagus is recommended. Of course this depends on the tolerance to such risky surgery, because most people with Barrett’s esophagus are older and have other medical problems that make surgery unwise. In these cases, endoscopic treatments would be recommended. The sooner treatment is underway after the diagnosis, the better chance the patient has for a cure.

Endoscopic Treatments

There are several endoscopic therapies that are used to treat severe dysplasia and cancer. These are only performed in special treatment centers by physicians who are specially trained in these procedures. The goal of the endoscopic treatment is to destroy or cut out the abnormal or cancerous lining of the esophagus, and increase the chance for normal tissue to grow.

Radiofrequency Ablation (BARRX). Eradication of abnormal cells is accomplished by the delivery of a predetermined level of radiofrequency energy to the esophageal lining. A R-F probe is fixed to a standard upper endoscope and guided into place under direct visualization using established endoscopic technique. The desired current is then applied to the area in question, thus destroying the abnormal cells. Normal esophageal lining then reemerges in the treatment field.

Photodynamic Therapy (PDT). PDT This procedure uses a light-sensitizing agent called Photofrin and a laser to kill precancerous and cancerous cells. This drug is then injected into a vein and the patient returns 48 hours later, the laser light is then passed through the endoscope and activates the Photofrin to destroy Barrett’s tissue in the esophagus.

Endoscopic Mucosal Resection (EMR). This procedure encompasses lifting the affected lining and injecting a solution under it or applying suction to it and then cutting it off. When this is completed, the lining is removed through the endoscope. If the cells are proven to be cancer, an endoscopic ultrasound is done first to make sure the cancer involves only the top layer of esophageal cells.

By treating and controlling acid reflux, can help to prevent or slow the progress of Barrett’s esophagus. Your doctor may recommend medications and or lifestyle changes such as:

  • Diet change, avoiding fatty foods, chocolate, caffeine, spicy foods, and peppermint.
  • Keep your head elevated when sleeping; it helps prevent the acid in your stomach from flowing up into the esophagus.
  • Do not lie down for 3 hours after eating a large meal
  • Drink plenty of water when taking medicines
  • Avoid alcohol, caffeinated drinks, and tobacco.
  • Obesity can lead to reflux, lose weight
  • Medicines the doctor may prescribe include: H2 blockers, antacids, promotility agents, and proton pump inhibitors which reduce the production of stomach acid.

Important facts to remember about Barrett's esophagus

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  • Barrett’s esophagus is linked with gastroesophageal reflux disease (GERD).
  • It’s important to have regular check-up through the use of endoscopies and biopsies if you have Barretts disease to make sure it does not develop into something even more serious
  • Diagnosis for Barrett’s esophagus is best accomplished using upper gastrointestinal endoscopy and biopsies.
  • Using acid-reducing drugs to improve GERD symptoms may help to decrease the risk of Barrett’s disease.
  • Endoscopic treatments destroy Barrett’s tissue with the intent that normal esophageal tissue will grow in its place.