Barrett’s esophagus

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.