Barrett’s esophagus is a serious complication of gastroesophageal reflux disease (GERD). GERD can be explained like this. When you swallow food, it passes through the tube from your mouth to the stomach. The tube is called esophagus, and at the end of it is the ring of muscle called lower esophageal sphincter (LES) which automatically closes once the food (or beverage) pass through. Your stomach produces acid in order to digest the food, hence, it is also protected by the acid it produces.
With GERD, the food contents flow backward to the esophagus causing a burning sensation to your chest. The process is called reflux.
In Barrett’s esophagus, the normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine. According to a report, about 10% of people with chronic symptoms of GERD develop Barrett’s esophagus. There are no specific symptoms for this condition, although patients might have symptoms that are related to GERD. Moreover, it increases the risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.
Do all people with GERD develop Barrett’s esophagus?
The answer is no.
Not all patients with GERD develop Barrett’s esophagus, and not all with Barrett’s esophagus had GERD. However, long-term GERD is the risk factor to have Barrett’s esophagus. In fact, most people with acid reflux don’t develop Barrett’s esophagus. But in patients with frequent acid reflux, the normal cells in the esophagus may eventually be replaced by cells that are similar to cells in the intestine to become Barrett’s esophagus.
How to diagnose Barrett’s esophagus?
It can only be diagnosed by endoscopy and bioscopy as there are no specific symptoms. Here is how endoscopy and biopsy performed.
The gastroenterologist will insert a long tube with a camera on the patient’s throat and inspect the lining of the esophagus. The gastroenterologist will also give the patient a sedative. The process may be uncomfortable but it isn’t painful. Most patients do not have any problem with it.
Barrett’s esophagus should be visible with the camera, but its diagnosis is only through biopsy. The gastroenterologist will collect a sample tissue from the esophagus and inspect it under the microscope in the laboratory. This process should confirm the diagnosis.
The sample will also be examined for the presence of any precancerous cell or cancer. If the biopsy confirms the presence of Barrett’s esophagus, your doctor will probably recommend a follow-up endoscopy and biopsy to examine more tissue for early signs of developing cancer.
If you have Barrett’s esophagus but no cancer or precancerous cells around it, the doctor will still most likely to recommend a periodic repeat endoscopy. This is a precaution as cancer can develop in Barrett tissue years after diagnosing Barrett’s esophagus. If precancerous cells are present in the biopsy, your doctor will discuss treatment and surveillance options with you. If you have Barrett’s esophagus but no cancer or precancerous cells around it, the doctor will still most likely to recommend a periodic repeat endoscopy. This is a precaution as cancer can develop in Barrett tissue years after diagnosing Barrett’s esophagus. If precancerous cells are present in the biopsy, your doctor will discuss treatment and surveillance options with you.
The American Gastroenterological Association (AGA) recommend screening in people who have a number of risk factors for Barrett’s esophagus. Risk factors include age over 50, male gender, hiatal hernia, white race, long-standing GERD, and overweight or obesity, especially if weight is carried around the mid-section of the body.
The goal of treatment in Barrett’s esophagus is to prevent the acid reflux. So number one on the treatment list is the lifestyle change which includes:
- Making changes in your diet. You should avoid eating fatty foods, spicy foods, chocolate, and peppermint as it can aggravate reflux. You should as well avoid drinking alcoholic and caffeinated drinks as it has the same effect.
- Quitting smoking. According to some studies, smoking is one of the reasons for the acid reflux to persist.
- Having a healthy weight. Being obese or overweight increases the risk of reflux.
- Sleeping with the head elevated on the bed. This may help prevent the acid in your stomach from flowing up into the esophagus.
- Lying down only 3 hours after you eat.
- If you are taking medication/s, take it all with plenty of water.
The doctors may also advise you to take some medication for the reflux. There are OTC (on-the-counter) medicines available that could help to relieve acid reflux. PPIs including omeprazole, rabeprazole, and esomeprazole; H2 blockers including cimetidine, ranitidine, and famotidine; and antacids are some of the main treatment options you can take.
PPIs and H2 blockers are both medications against acid reflux in GERD. The two decreases acid production and reduce the potential for damage caused by acid reflux. These are noted to be generally safe and effective medication but they are not appropriate for all people with reflux disease and can cause side effect just like any prescription drug. For instance, they can cause problems absorbing nutrients which leads to malnutrition. Antacids are also helpful in neutralizing the stomach acid.
There are several treatments, including surgery, that are specifically targetting Barrett’s esophagus. They are designed to focus on the abnormal tissue. These are:
Radiofrequency ablation (RFA)
This uses radio waves that are delivered through an endoscope inserted into the esophagus to destroy abnormal cells and at the same time protecting the healthy cells underneath.
Photodynamic therapy (PDT),
PDT, on the other hand, uses a laser through an endoscope to kill the abnormal cells in the lining of the esophagus without damaging the normal tissue. The patient takes a drug known as Photofrin that causes the cells to become light-sensitive before the beginning of the procedure.
Endoscopic mucosal resection (EMR)
EMR lifts the abnormal lining and cuts it off the wall of the esophagus before it’s removed through the endoscope. An ultrasound is done first before the procedure as the goal of the treatment is to remove any precancerous or cancer cells in the lining.
Endoscopic spray cryotherapy
This is a newer method where doctors apply cold nitrogen or carbon dioxide gas, through the endoscope to freeze the abnormal cells.