Barrett’s esophagus affects more than 3 million people in the United States. The condition emerges when the cells lining the lower esophagus mutate, becoming more like those in the stomach and intestine due to repeated gastroesophageal reflux (GERD, or chronic heartburn). Barrett’s also is closely associated with obesity, and its incidence has risen recently.
Initially, physicians typically prescribe acid-blocking drugs and watch for the signs of dysplasia, which suggests that the condition is developing into cancer. If medications do not stop heartburn and other symptoms of GERD
, then a laparoscopic fundoplication
should be considered. A recent procedure enables physicians to use radiofrequency ablation to remove the diseased tissue. In advanced cases the physician might recommend removing the patient's esophagus
In a fraction (<1 percent) of people with Barrett’s, the mutating cells turn cancerous, developing into esophageal adenocarcinoma, which historically is difficult to treat successfully.
SymptomsBarrett’s esophagus does not produce symptoms on its own; patients experience the heartburn and acid reflux into the mouth that stems from GERD, and also might suffer from peptic ulcers or esophageal scarring and narrowing – again, caused by GERD. Curiously, the mutation of esophageal cells also might actually reduce the inflammation caused by GERD, as the stomach/intestinal cells can better withstand the refluxing acid.
CausesSome evidence suggests Barrett's esophagus is a congenital disorder, but it is most strongly associated with long-term cases of GERD.
Risk FactorsGERD is the strongest indicator of potential for Barrett’s esophagus. Family history of the disorder also would be a risk factor. The average age of a patient with Barrett’s is 60, but many physicians recommend that adults over 40 who have had GERD for years be screened for Barrett’s. The disorder is three times more prevalent in males than in females, and more common in white men than in men of other races.
DiagnosisA specialist diagnoses Barrett’s by examining the patient’s esophagus with a thin, flexible tube called an endoscope. The endoscope is directed down the patient’s throat, into the esophagus. Its end has a light and miniature camera, enabling the physician to view the anatomy up-close on a video monitor. The camera also produces high-resolution images, which the physician can study or use in consultation with another specialist.
If the tissue’s appearance suggests Barrett’s, the physician can biopsy it – remove a small piece –with a device connected to the endoscope. A pathologist examines the biopsied tissue to confirm the Barrett’s diagnosis.
Screening for this condition is not recommended for people who have not experienced symptoms.
ComplicationsBarrett’s esophagus is a major risk for developing esophageal adenocarcinoma, whose incidence is six times higher than it was in 1975. Adenocarcinoma, as well as the precancerous cells that presage its emergence, are both difficult to treat.
RecoveryChanges to diet that reduce GERD symptoms, as well as increased physical activity can reduce potential for developing Barrett’s esophagus or, in established cases, slow its advance to a precancerous state. Such a diet would avoid food and drink that could irritate the esophagus (e.g., peppers, citrus, tomato), alcohol and caffeine intake, and meals with high fat content. Smaller, more frequent meals and increased water intake also are beneficial.