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Barrett’s esophagus occurs when the lining of the esophagus, the tube connecting the mouth to the stomach, becomes thicker and redder due to acid reflux. This condition is usually caused by a weakened lower esophageal sphincter (LES), which leads to damage from acid and chemicals. Gastroesophageal reflux disease (GERD) often accompanies Barrett’s esophagus and can cause symptoms like heartburn or regurgitation. In some cases, GERD can lead to changes in the cells of the lower esophagus, resulting in Barrett’s esophagus.
Barrett’s esophagus is associated with a slightly increased risk of esophageal cancer, although the actual likelihood is low. Regular checkups involving thorough imaging and biopsies of the esophagus are crucial to detect any precancerous cells called dysplasia. If precancerous cells are found, appropriate treatment can be administered to prevent the development of esophageal cancer.
The treatment for Barrett’s esophagus depends on the extent of abnormal cell growth and the overall health of the individual. It may involve medications to reduce acid reflux, lifestyle changes, endoscopic procedures to remove abnormal tissue, or surgery in severe cases. The treatment plan is tailored to the individual’s circumstances to effectively manage the condition and minimize the risk of esophageal cancer.
Symptoms
Barrett’s esophagus typically does not manifest with noticeable symptoms, but it is important to be vigilant for indications of its associated conditions, namely frequent heartburn, and acid regurgitation. The most significant warning sign is experiencing heartburn at least twice a week. Heartburn is characterized by a burning sensation in the chest and the presence of vomit in the back of the throat, which signals acid regurgitation.
Common signs and symptoms related to Barrett’s esophagus include:
- Heartburn, that occurs at least twice a week and intensifies
- Acid regurgitation
- Painful or difficulty swallowing
- Sore throat, foul taste in the mouth, or unpleasant breath on a regular basis
- Unexplained weight loss
- Vomiting
- Chest pain, rarely
If any of the signs and symptoms related to Barrett’s esophagus or GERD persists, consult a healthcare provider for proper diagnosis and treatment.
Emergency consultation may be necessary when one experiences chest pain, trouble swallowing, has blood on stool, vomiting, or has unexplained weight loss. People who have untreated heartburn on a regular basis are considerably more prone to acquire Barrett’s esophagus.
Causes
Barrett’s esophagus can be attributed to several factors. However, the definite cause is unknown. It is more common among GERD patients. With GERD, the stomach contents run backward into the esophagus. Experts believe that the acidic liquid irritates the esophageal lining, causing tissue damage or alterations.
However, Barrett’s esophagus can exist in the absence of GERD. While many people with Barrett’s esophagus have long-term GERD, many have no reflux symptoms, which is referred to as “silent reflux.”
Risk factors
There are multiple factors that can influence the likelihood of developing Barrett’s esophagus, including:
- Family history: Having a parent or a family member who had Barrett’s esophagus or esophageal cancer increases one’s chance of having it as well.
- Gender: Barrett’s esophagus is significantly more common in men.
- Ethnicity: Being white and non-Hispanic increases the risk of Barrett’s esophagus.
- Age: Adults over the age of 50 are more susceptible to this condition.
- Chronic heartburn and acid reflux: People who have experienced heartburn problems for nearly a decade, have GERD requiring frequent medication, or have GERD that does not improve despite taking proton pump inhibitor drugs, are at a higher risk of developing Barrett’s esophagus.
- Smoking: A former and current smoker has an increased risk of this disease.
- Obesity: The chance of developing Barrett’s esophagus is higher with people who have excessive weight, particularly those with too much fat in the abdomen area.
Diagnosis
The diagnosis of Barrett’s esophagus often begins with assessing the symptoms, evaluating one’s medical history, and performing an endoscopy. An upper endoscopy is the only approach to confirm the diagnosis of Barrett’s esophagus.
While the appearance of the esophagus may suggest Barrett’s esophagus, only small samples of tissue or biopsies can confirm the diagnosis. Laboratory analysis of the tissue is required to make the diagnosis and determine the degree of tissue change.
During the procedure, a short lighted tube, also known as endoscope, is inserted down the throat and into the esophagus to search for changes in the lining of the esophagus. Normal esophageal tissue is pale and shiny.
Determining the extent of tissue change: Dysplasia is the presence of precancerous cells. Esophageal dysplasia can be difficult to diagnose. Two pathologists may be necessary to confirm the diagnosis, including at least one specializing in gastrointestinal pathology. The laboratory analysis can identify the degree of dysplasia in the esophageal cells. Tissue sample is categorized by:
- No dysplasia. Confirmed Barrett’s esophagus but with no precancerous alterations in the cells.
- Low-grade dysplasia. Confirmed Barrett’s esophagus with minor precancerous alterations or some abnormal cells.
- High-grade dysplasia. This is regarded to be the last stage of esophageal cancer development. The patient has confirmed Barrett’s esophagus with substantial changes in the esophagus lining or several alterations in the cells.
Screening for Barrett’s esophagus: Men who have at least two risk factors including weekly occurrence of GERD symptoms and failure to respond to proton pump inhibitor treatment should undergo screening for Barrett’s esophagus according to the American College of Gastroenterology.
Women, although less likely to have Barrett’s esophagus, should also be examined particularly when they experience uncontrolled reflux or checks out other risk factors.
Treatment
Treatment for Barrett’s esophagus is mostly determined by the existence of symptoms and dysplasia on biopsies as well as one’s overall health.
- Without dysplasia: No dysplasia indicates that the doctor did not find precancerous cells. Treatment is usually not required at this time. However, the doctor may advise:
- Regular endoscopy: The doctor may require an upper endoscopy every two to three years to check for any changes in the cells in the esophagus.
- GERD treatment: Those who have GERD may be prescribed with medications. These medications reduce stomach acid, which can protect the esophagus. Surgery or endoscopic techniques to repair a hiatal hernia or tighten the lower esophageal sphincter, which controls the flow of stomach acid, may be options.
Lifestyle modifications, such as sleeping slightly inclined and avoiding eating meals late, can also be beneficial.
- Low-grade dysplasia: Low-grade dysplasia indicates that the patient may have some abnormal cells, but the vast majority are unaffected. This is the first stage of precancerous alterations. In this case, the doctor may need to perform frequent checks to see if any further changes occur. Upper endoscopies should be performed every six months to a year.
In some cases, if the diagnosis is confirmed, several treatments may be necessary to manage the risk of esophageal cancer. If considerable esophageal inflammation is found during the initial endoscopy, another endoscopy will be done after three to four months of stomach acid reduction medication.
- Other treatments that may be required are:
- Endoscopic mucosal resection: Precancerous lesions on the esophageal lining are removed with an endoscope.
- Radiofrequency ablation: This is often recommended after endoscopic resection. It burns away abnormal tissue with radio waves, which produce heat.
- Cryotherapy: This involves the use of liquid nitrogen to freeze damaged sections of the esophagus lining, causing them to shed off. The freezing and thawing cycle harms the aberrant cells.
- High-grade dysplasia: High-grade dysplasia suggests a significant change in the lining of the esophagus. Cancer is more likely with this diagnosis. Upper endoscopies may need to be repeated more frequently to look for malignancy. The doctor may advise endoscopic resection, radiofrequency ablation, or cryotherapy. Lifetime medications may be prescribed to lower acid and help the esophagus repair.
Severe dysplasia or esophageal cancer may require an esophagectomy. This is a surgical procedure which entails removing the damaged segment of the esophagus and reconnecting the remaining portion to the stomach. In some cases, it may also lead to removing all the esophagus.
Barrett’s esophagus may recur following treatment. Follow-up checkups and regularly scheduled endoscopy tests may help ensure that everything is normal. Lifestyle change may also assist manage the symptoms of GERD.
