Often the result of GERD, this condition can be a precursor to America’s fastest growing type of cancer. A new treatment helps lower the toll.
Barrett’s esophagus is a condition in which the lining of the esophagus, the tube that connects the mouth to the stomach, is replaced by tissue that is similar to the lining of the stomach, most often in response to the effects of chronic acid reflux.
The ends of the esophagus are normally pinched together by sphincter muscles. The sphincters relax to allow food or drink to pass from the mouth into the stomach, and then close rapidly to prevent the food or drink, and stomach acids, from leaking back into the esophagus and mouth.
When the lower sphincter fails to close, however, stomach acid washes back and touches the lining of the esophagus. This is called gastroesophageal reflux (GER), and can cause the burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common, but can progress to the more chronic condition known as gastroesophageal reflux disease, or GERD.
Reflux that occurs more than twice a week is considered GERD. With about 20 percent of Americans experiencing GERD symptoms every day, it is one of the most common medical conditions. GERD can eventually lead to more serious health problems, including Barrett’s. “Because the environment of the esophagus is now acidic, the cells evolve to be more like stomach lining cells in order to withstand that acid exposure,” says Robert S. Dean, M.D., of Premier Medical Group’s Gastroenterology Division.
Diagnosis and Treatments
Typically, there are no signs or symptoms associated with Barrett’s esophagus—which affects about one percent of adults in the U.S.— and most of the time the condition is harmless. “But between 0.13 percent and 0.5 percent of Barrett’s patients are at risk of developing esophageal adenocarcinoma,” Dr. Dean says. “It’s not that common, but this is the fastest growing cancer in the U.S., and most of it has to do with acid reflux.”
The American Gastroenterological Association recommends that persons over 40 with longstanding chronic GERD, the at-risk population, receive endoscopic examinations and biopsies to look for early warning signs of cancer. Typically, precancerous cells appear in the Barrett’s tissue first. This condition is called dysplasia and can be seen only through biopsies. Detecting and treating dysplasia may prevent cancer from developing.
“There is a sequence of cellular changes as it progresses from Barrett’s to cancer,” Dr. Dean says. These progressions are graded as low-grade and high-grade dysplasia. “With low-grade dysplasia, we historically just watched and waited, with periodic endoscopy and biopsy,” he says. “But with new technologies like the HALO System we are more aggressive in removing even low-grade dysplasia. With high-grade, the possibility of cancer is more imminent, and interventional therapy is needed.”
Therapies include endoscopic or surgical treatments to treat the disease. During these therapies, the Barrett’s lining is destroyed or the portion of the lining that has dysplasia or cancer is cut out. The goal of the treatment is to encourage normal esophageal tissue to replace the destroyed lining. Surgical removal of most of the esophagus is recommended if a person with Barrett’s esophagus is found to have severe dysplasia or cancer and can tolerate a surgical procedure. Surgery soon after diagnosis of severe dysplasia or cancer may provide the patient with the best chance for a cure.
The key, though, is early diagnosis. When this potentially deadly cancer is not detected until its later stages, treatments may not be effective. “The more Barrett’s we diagnose, the fewer cases we see turning into cancer,” says Dean.