What is
Barrett’s esophagus?
Barrett’s esophagus is a condition in which the tissue lining the
esophagus—the muscular tube that connects the mouth to the
stomach—is replaced by tissue that is similar to the lining of the
intestine. This process is called intestinal metaplasia.
No signs or symptoms are associated with Barrett’s esophagus, but
it is commonly found in people with gastroesophageal reflux
disease (GERD). A small number of people with Barrett’s esophagus
develop a rare but often deadly type of cancer of the esophagus.
Causes
When you eat, food passes from the throat to the stomach through
the esophagus (also called the food pipe or swallowing tube). Once
food is in the stomach, a ring of muscles keeps it from leaking
backward into the esophagus.
If these muscles do not close tightly, stomach acid can leak back
into the esophagus. This is called reflux or gastroesophageal
reflux.
This reflux may cause symptoms of heartburn. It may also damage
the lining of the esophagus, which is referred to as Barrett's
esophagus.
Barrett's esophagus occurs more often in men than women. You are
more likely to have this condition if you have had GERD for a long
time.
Patients with Barrett's esophagus may develop more changes in the
esophagus called dysplasia. When dysplasia is present, the risk of
getting cancer of the esophagus increases.
Symptoms
Barrett's esophagus itself does not cause symptoms. The acid
reflux that causes Barrett's esophagus often leads to symptoms of
heartburn. However, many patients with this condition do not have
symptoms.
Prevention
Diagnosis and treatment of GERD may prevent Barrett's esophagus.
How is Barrett’s
esophagus diagnosed?
Because Barrett’s esophagus does not cause any symptoms, many
physicians recommend that adults older than 40 who have had GERD
for a number of years undergo an endoscopy and biopsies to check
for the condition.
Barrett’s esophagus can only be diagnosed using an upper
gastrointestinal (GI) endoscopy to obtain biopsies of the
esophagus. In an upper GI endoscopy, after the patient is sedated,
the doctor inserts a flexible tube called an endoscope, which has
a light and a miniature camera, into the esophagus. If the tissue
appears suspicious, the doctor removes several small pieces using
a pincher-like device that is passed through the endoscope.
Exams and Tests
If GERD symptoms are severe or they come back after you have been
treated, the doctor may perform an endoscopy.
• A thin tube with a camera on the end is inserted through your
mouth and then passed into your esophagus and stomach.
• While looking at the esophagus with the endoscope, the doctor
may perform biopsies in different parts of the esophagus. These
biopsies help diagnose Barrett's esophagus, as well as look for
changes that could lead to cancer.
Follow-up endoscopies may be recommended for some patients.
Treatment
Treatment should improve symptoms, and may keep Barrett's
esophagus from getting worse.
Lifestyle changes include:
• Avoid dietary fat, chocolate, caffeine, and peppermint because
they may cause lower esophageal pressure and allow stomach acid to
flow backwards
• Avoid alcohol and tobacco
• Avoid lying down after meals
• Lose weight
• Sleep with the head of the bed elevated
• Take all medications with plenty of water
Medications to relieve symptoms and control gastroesophageal
reflux include:
• Proton pump inhibitors
• Antacids after meals and at bedtime
• Histamine H2 receptor blockers
• Promotility agents
Anti-reflux surgery may help with symptoms of GERD, but will not
cause Barrett's esophagus to go away.
TREATMENT OF BARRETT'S
ESOPHAGUS
Surgery or other procedures may be recommended if a biopsy shows
cell changes that are very likely to lead to cancer. Such changes
are called severe or high-grade dysplasia.
Some of these procedures remove the harmful tissue in your
esophagus, where the cancer is most likely to develop.
• Photodynamic therapy (PDT) involves the use of a special laser
device, called an esophageal balloon, along with a drug called
Photofrin.
• Other procedures use different types of high energy to destroy
the precancerous tissue.
• Surgery to remove the abnormal lining
Outlook (Prognosis)
People with Barrett's esophagus have an increased risk of
esophageal cancer. Still, only a small number of people with
Barrett's esophagus develop cancer. Follow-up endoscopy to look
for dysplasia or cancer is often advised.
Treatment should improve symptoms and may keep Barrett's esophagus
from getting worse. None of these treatments will reverse the
changes that may lead to cancer.
When to
Contact a Medical Professional
Call your health care provider if:
• Heartburn lasts for longer than a few days, or you have pain or
difficulty swallowing.
• You have been diagnosed with Barrett's esophagus and your
symptoms get worse, or new symptoms (weight loss, problems
swallowing) develop.
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