Barrett's esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine.
This occurs in the area where the esophagus is joined to the stomach. It is believed that the main reason that Barrett's esophagus develops is because of chronic inflammation resulting from Gastroesophageal Reflux Disease (GERD). Barrett's esophagus is more common in people who have had GERD for a long period of time or who developed it at a young age. Interestingly the frequency and the intensity of GERD symptoms do not affect the likelihood that someone will develop Barrett's esophagus.
Most patients with Barrett's esophagus will not develop cancer. In some patients, however, a precancerous change in the tissue, called dysplasia, will develop. Patients who show evidence of dysplasia are more likely to develop esophageal cancer, specifically esophageal adenocarcinoma which is a serious and potentially fatal form of cancer.
Barrett's esophagus does not have any specific symptoms, although patients with Barrett's esophagus may have symptoms related to gastroesophageal reflux disorder (GERD).
Currently, a diagnosis of Barrett's esophagus can only be made using endoscopy and detecting a change in the lining of the esophagus that can be confirmed by a biopsy of the tissue.
One of the primary goals of treatment is to prevent or slow the development of Barrett's esophagus by treating and controlling acid reflux. This is done with lifestyle changes and medication. Lifestyle changes include taking steps such as:
- Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can aggravate reflux.
- Avoid alcohol, caffeinated drinks, and tobacco.
- Weight loss.
- Sleep with the head of the bed elevated to help prevent stomach acid from flowing up into the esophagus.
- Don't lie down for 3 hours after eating.
- Take all medicines with plenty of water.
The doctor may also prescribe medications to help. Those medications may include:
- Proton pump inhibitors that reduce the production of stomach acid
- Antacids to neutralize stomach acid
- H2 blockers that lessen the release of stomach acid
- Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines
There are several treatments, including surgery, that are designed specifically to focus on the abnormal tissue associated with Barrett’s esophagus. They include:
- Photodynamic therapy (PDT) uses a laser that's inserted into the esophagus with an endoscope to kill abnormal cells in the lining without damaging normal tissue.
- Endoscopic mucosal resection (EMR) lifts the abnormal lining and cuts it off the wall of the esophagus before it's removed through the endoscope. The goal is to remove any precancerous or cancerous cells contained in the lining. If cancer cells are present, an ultrasound is done to be sure the cancer hasn't moved deeper into the esophagus walls.
- Surgery to remove a portion of the esophagus. This is an option in cases where severe precancerous changes (dysplasia) or cancer has been diagnosed. The earlier the surgery is done following the diagnosis, the better the chance for the cure.