The most common cause of Barrett’s esophagus is long term gastro-esophageal reflux disease (GERD). GERD is the acid reflux that is experienced as heartburn.
Barrett’s esophagus is found most often in white males over the age of 50.
When the esophageal lining is irritated long enough by the stomach acid and other chemicals being regurgitated into it, it develops a makeshift defense. The body starts replacing the normal squamous type cells that line the esophagus with intestinal-type cells that are better suited to dealing with these chemicals. (When cells develop out of their usual location in the body like this, it’s called metaplasia.) This condition is Barrett’s esophagus.
Unfortunately, while this can indeed decrease the discomfort of heartburn, it greatly increases the risk of esophageal cancer. People with Barrett’s esophagus have an estimated 30-125 times greater likelihood of getting cancer of the esophagus than do people without Barrett’s esophagus. The metaplasia can develop into precancerous dysplasia, which is when the cells develop abnormally with a delayed maturation, which can then develop into cancer.
Because Barrett’s esophagus can lead to cancer, people with chronic GERD, especially older white males, are urged to have their condition examined by a doctor.
The diagnostic method used to detect Barrett’s esophagus is the endoscopy. An endoscope is a slim, flexible tube with a tiny camera on the end that is inserted through the mouth into the esophagus. Images are taken with the camera, and a biopsy is examined under a microscope to determine if Barrett’s esophagus is present.
Treatment for Barrett’s esophagus can vary, depending in part on the degree of dysplasia, if any, detected.
If needed, follow up endoscopies on a regular basis can be used to track any further development, and certainly to detect if and when cancer appears.
For as long as no dysplasia or only low grade dysplasia is detected, the usual course of action is antireflux therapy to treat the GERD. This means seeking to decrease the acid and other chemicals regurgitated into the esophagus, improve esophageal clearance, and protect the esophageal lining.
A change of diet is often recommended. Certain substances such as alcohol, caffeine, chocolate, nicotine, peppermint, and raw onions can increase reflux. Patients may be advised to avoid large or high-fat meals.
A change of sleep habits can also be advised. If the head of the bed is elevated, this can decrease the amount of reflux that occurs during the night. Avoiding going to bed within three hours of eating can also help.
There are both over-the-counter (e.g., Rolaids, Tums) and prescription (e.g., Prilosec, Zantac) drugs available to reduce stomach acid.
If higher grade dysplasia is detected, and the risk of cancer heightened, more aggressive treatments may be tried.
There are forms of ablation that can be used, including radiofrequency ablation. This involves inserting a balloon filled with electrodes into the esophagus, which then emits short bursts of energy to burn away the damaged cells.
Another treatment is called photodynamic therapy. A photosensitizing agent is given intravenously or orally to the patient. This causes light-sensitive cells to accumulate in the lining of the esophagus. Laser light is then used to cause these cells to produce cytotoxic oxygen free radicals to kill nearby cells.
Yet another option is endoscopic surgery. Surgical tools are passed down through the endoscope and used to resect the damaged cells.
It is also possible to surgically remove the damaged part of the esophagus. The remaining esophagus is then reattached to the stomach.
The key of course is to catch it as early as possible. If diagnosed early, Barrett’s esophagus can generally be treated in such a way as to prevent or cure cancer. But if left untreated, a little heartburn can develop into something vastly worse.
“Barrett’s Esophagus.” Johns Hopkins Pathology.
“Barrett’s Esophagus.” Mayo Clinic.
“Barrett’s Esophagus: Symptoms, Causes, and Treatments.” WebMD.