What is Barrett’s Esophagus?
Barrett’s esophagus, or “Barrett’s type changes” of the esophagus describe an abnormal condition which changes the cell type of the esophageal lining and increases the chances of esophageal cancer. When the normal tissue lining the esophagus (the tube that connects the mouth to the stomach) changes to tissue that more resembles the intestinal lining instead of the typical appearance of the esophageal lining, it is called Barrett’s Esophagus. The cells change from squamous type skin cells like the ones on our skin, to cells similar to the lining of the intestinal (gut) surface.
It is a long-term complication of Gastroesophageal Reflux Disease (GERD). Only a few people with GERD develop Barrett’s Esophagus. However, it may be associated with an increased risk of developing cancer. Therefore, it is important to have regular checkups if you have developed Barrett’s Esophagus to detect precancerous cells.
Around 10% to 15% of people with GERD will develop Barrett’s Esophagus. It affects men twice as much as women and is usually diagnosed after the age of 55.
We perform lots of laparoscopic fundoplication procedures for patients that have developed Barrett’s esophagus type changes.
What are the Symptoms of Barrett’s Esophagus?
There are no definite symptoms for Barrett’s Esophagus. In fact, up to 25% of people with Barrett’s esophagus changes do not have any symptoms. The symptoms are generally due to the underlying cause, GERD, and may include:
- Frequent heartburn
- Regurgitation of undigested food or acid
- Difficulty swallowing
- Chest pain or upper abdominal pressure and pain
- Cough
- Frequent throat clearing
- Persistent hoarseness and/or sore throat
What are the Causes of Barrett’s Esophagus?
The exact reason for this condition is not fully known, but most people with Barrett’s Esophagus usually have suffered from long-term GERD. People with GERD have a 3 to 5 times higher risk of developing Barrett’s Esophagus.
In GERD, stomach acid flows abnormally upwards, into the esophagus, damaging the tissue. As the healing occurs, the cells of the esophagus may change into the type of cells found in the intestine. (However, some people with Barrett’s Esophagus may not have experienced heartburn or GERD.These people suffer from “silent reflux”)
When to see a Doctor?
If you have been experiencing acid reflux or heartburn for more than 5 years, ask your doctor about the risk of developing Barrett’s Esophagus and consider a workup to diagnose your cause of GERD.
Seek immediate medical care if you:
- Are vomiting blood
- Are passing blood in stools
- Have severe chest pain that may be a symptom of a heart attack
- Have difficulty swallowing with food getting stuck
What are the Complications of Barrett’s Esophagus?
Increased risk of esophageal cancer is the main complication of Barrett’s Esophagus. Esophageal cancer is a “bad actor” cancer that is frequently beyond the ability to fully cure when it is discovered. Less than 1 in 5 patients with esophageal cancer are alive at 5 years after diagnosis. Most people with Barrett’s Esophagus do not develop cancer. It is estimated that 0.5% of people with Barrett’s Esophagus develop cancer. This is a 1/200 chance which is low, but is present each year the patient lives with the Barrett’s type changes. Therefore, the risk is cumulative as the patient lives with the condition. It appears that the increased risk of developing esophageal adenocarcinoma in patients with Barrett’s is about 30 times greater than those without Barrett’s.
Fundoplication surgery can prevent or regress changes of Barrett’s esophagus.
How is Barrett’s Esophagus Diagnosed?
Barrett’s Esophagus is diagnosed by Endoscopy, which is performed by a doctor. An endoscope (a thin tube the diameter of your small finger with a light and a camera at the end) is passed down the throat to check for the changes in the esophageal tissue or other problems. Normal esophagus lining appears glossy white and pale. The tissue appears red and velvety in the case of Barrett’s Esophagus. It has been described as salmon in color.
Xrays during a barium swallow, or an esophagram, can sometimes show irregularities in the lining of the esophagus, but for an actual tissue diagnosis and especially to determine the degree of Barrett’s changes, an endoscopy is required.
The doctor may remove a tiny piece of tissue (biopsy) from the esophagus to send it for further investigation. It will be examined for “dysplasia” or the development of abnormal cells. Dysplasia describes changes seen in a cell that are steps toward cancer. The tissue sample is ranked based on the degree of dysplasia:
No Dysplasia
No cell abnormalities
Low-Grade Dysplasia
Small amount of cell abnormalities or precancerous changes
High-Grade Dysplasia
Large amount of cell abnormalities or precancerous changes
What is the Treatment of Barrett’s Esophagus?
Treatment depends on grades of dysplasia and may include:
No Dysplasia:
- Periodic endoscopy to monitor the cells of the esophagus
- Treatment of GERD with medications and lifestyle changes
- Surgery with a laparoscopic fundoplication procedure
Low-Grade Dysplasia:
- Endoscopic Resection: Damaged cells are removed by using an endoscope
- Radiofrequency Ablation: Heat is used to remove the abnormal tissue
- Surgery with a laparoscopic fundoplication procedure
High-Grade Dysplasia:
This condition is thought to be a precursor of cancer. Therefore, the doctor may recommend endoscopic resection and other procedures like:
- Cryotherapy: Cold liquid or gas is applied to the damaged part with an endoscope to destroy the cells
- Surgery (esophagectomy): The damaged part of the esophagus is removed surgically.