Barrett’s esophagus is a serious complication of heartburn and GERD (gastroesophageal reflux disease) but is seen in only a small percentage of patients with GERD — about 5%-10%. This disease affects men twice as much as women. The condition occurs when there is a change in the mucosal cells lining the esophagus from normal stratified epithelium to columnar epithelium (the normal structure of the lining of the small intestine). Medically, this change is termed metaplasia. Barrett’s esophagus needs to be taken seriously as there is a high probability of developing esophageal adenocarcinoma; a deadly form of cancer due to this. The precancerous condition is termed dysplasia. However, the occurrence of cancer is relatively rare.
An accurate cause of Barrett’s esophagus is not known as yet but heartburn and GERD are known to be precursors to this disease. The presence of bile acids (from the liver) and pancreatic enzymes (from the duodenum) are also known to be injurious to the esophageal lining.
The risk factors include:
- Having symptoms of heartburn and GERD
- Being a Caucasian male
- Being above 50 years of age
- Being overweight, especially with high levels of belly fat
- Hereditary factors
The medical fraternity is divided into two factions regarding other factors that can worsen this condition. The first factor is having Helicobacter pylori (H. pylori) infection, and the second is the frequent use of aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs). Some state that these two factors can contribute to the progression of GERD to Barrett’s esophagus, while others have an opposing view.
Barrett’s esophagus is diagnosed based on the patient’s history and physical examination. The physician may conduct an upper gastrointestinal (GI) endoscopy and biopsy. The endoscope is used to see the lining of the esophagus, stomach, and the duodenum. Small pieces of tissue are taken from at least eight different locations in the lower end of the esophagus.
Once the condition is identified, repeat endoscopy examinations are conducted after 1 year, and if no tissue change is observed, once every 3 years. If there are tissue changes, the frequency will be increased to between 6 months and 1 year.
Like heartburn and GERD, treatment is dependent on the severity of the condition. Conditions with mild or no tissue change will be treated with medication to control GERD, namely, antacids and anti-histamines. The former is used to neutralize the acid in the stomach while the latter is used to reduce the production of acid in the stomach.
If the condition is accompanied by low-grade dysplasia, then the preferred treatments may include endoscopic resection and radiofrequency ablation. If there is high-grade dysplasia, the following treatments are prescribed:
- Cryotherapy: An endoscope is used to apply cold fluids to the abnormal cells which are then allowed to warm up again. Repeated cycles of freezing and thawing kill the cells.
- Photodynamic therapy: A procedure where the damaged cells are made sensitive to light using a light-activated chemical. A laser is used to then destroy the cells.
- Esophagectomy: A surgical procedure that removes the damaged portions of the esophagus after which the remaining part is attached to the stomach.
Barrett’s esophagus can be controlled with a diet high in fresh vegetables and fruits. Other lifestyle changes include:
- Avoiding tight-fitting clothes
- Maintaining a healthy weight
- Avoid lying down or bending after meals
- Using high pillows to raise the head and chest while lying down and sleeping
- Avoiding foods that trigger heartburn
Patients with Barrett’s esophagus can lead healthy lives as long as they are constantly monitored for any changes in the cells in the esophagus that may lead to cancer.