Barrett’s esophagus

Definition

Barrett's esophagus is a disorder in which the lining of the esophagus (the tube that carries food from the throat to the stomach) is damaged by stomach acid.

See also: Gastroesophageal reflux disease (GERD)

Causes, incidence, and risk factors

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.

Signs 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 OF GERD

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

Expectations (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.

Calling your health care provider

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.

Prevention

Diagnosis and treatment of GERD may prevent Barrett's esophagus.

References

Wilson, J F. In the clinic. Gastroesophageal reflux disease. Ann Intern Med. 2008; 149(3):ITC2-1-15; quiz ITC2-16.

Wang, K K and Sampliner, R E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3): 788-97.

Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009;360:2277-2288.