Barrett’s esophagus is most often caused by gastro-esophageal reflux disease (GERD), which is the acid reflux that gives rise to the symptom experienced as heartburn. It is a condition that afflicts primarily white males over the age of 50.
Stomach acid and other chemicals found in the stomach and intestines tend not to irritate those organs due to their being lined with cells that prevent that from happening. However, these same acids can be highly irritating to the esophagus, where they do not belong, because the esophagus is lined with squamous cells, a different kind of cell.
When someone suffers from GERD long enough, the body sometimes reacts by developing intestinal cells instead of squamous cells to line the esophagus. This condition is called Barrett’s esophagus.
Now at first glance, it seems to be an ingenious and welcome maneuver, as these cells often succeed in protecting the esophagus, reducing the discomfort of what had been chronic heartburn.
Unfortunately, Barrett’s esophagus comes with a major downside. When these out-of-place cells develop (a process called metaplasia), this can sometimes turn into dysplasia, which is a precancerous condition where the cells develop in an abnormal way where maturation is delayed. This in turn can develop into cancer of the esophagus. If that spreads, it can be incurable.
How big a risk is there of this happening? It is estimated that people with Barrett’s esophagus are 30-125 times more likely to develop esophageal cancer than people without the condition.
So better the heartburn, than this defense against it.
Treatment is available, however. Which treatment is best, and how effective it is likely to be, depends in part on how far the condition has developed. If Barrett’s esophagus is detected early before it has developed into cancer, cancer can generally be prevented. Even if it’s caught fairly early in its cancerous stage, treatment may still be possible.
To determine if a patient with GERD has developed Barrett’s esophagus, and to determine how far along any process of dysplasia is, the diagnostic tool now generally used is the endoscope.
An endoscope is a slim, flexible tube with a tiny camera on the end that is inserted through the patient’s mouth into the esophagus. Images are taken with the camera, and a biopsy is taken to be examined under a microscope to determine the presence of Barrett’s esophagus.
If the results of the endoscopy are ambiguous, the doctor may well opt for a wait-and-see strategy of treating the GERD and repeating the endoscopy several weeks later. The purpose of the treatment is to decrease acid reflux into the esophagus, improve esophageal clearance, and protect the esophageal lining.
For low grade dysplasia or ambiguous cases, antireflux therapy can be as mild as having the patient tilt their bed slightly so that they sleep with the head elevated. Patients may also be advised to avoid eating within three hours of going to bed, and to lose weight. Reflux can also potentially be lessened by eliminating or decreasing the frequency of consumption of large or high-fat meals, alcohol, caffeine, chocolate, nicotine, peppermint, and raw onions.
There are also many medications, both prescription and over-the-counter, that can be used. Among these are Axid, Pepcid, Tagamet, Zantac, Rolaids, or Tums, as well as proton pump inhibitors such as Prilosec or Prevacid.
For higher grade dysplasia, the esophagus is mapped, and more frequent endoscopies with biopsies are done to track the development of the dysplasia and detect any cancer.
From there, there are many treatment options. Some are forms of ablation that are still being studied to better determine their long term effectiveness and safety. Radiofrequency ablation is done by inserting a balloon filled with electrodes into the esophagus, where it emits short bursts of energy to burn away the target cells.
Another option is photodynamic therapy, where a photosensitizing agent is given to the patient. This causes light-sensitive cells to accumulate in the skin (bad-you become highly susceptible to sunburn and have to stay out of direct sunlight for several weeks) and the lining of the esophagus (good-laser light is then used to cause these cells to produce cytotoxic oxygen free radicals to kill nearby cells). Sometimes this treatment does not kill all the cells it’s supposed to, plus there is a 10%-30% risk of a narrowing of the esophagus that can impede swallowing.
It is also possible to use special little surgical tools passed down the endoscope to try to resect the target cells. This too is not guaranteed to cut away all the intended cells, plus it can cause bleeding, tearing, or narrowing of the esophagus.
If all else fails, another option is to go in surgically and remove part of the esophagus, and then reattach what’s left of the esophagus to the stomach.
If dysplasia has developed into cancer, but it has not spread to where it is untreatable, treatment can be chemotherapy, radiation therapy, surgery, or a combination thereof.
Certainly a diagnosis of Barrett’s esophagus is not a death sentence. The earlier it is detected and treated, the more likely it can be dealt with successfully through something as simple as taking some antacid pills and not eating right before you go to bed. But the farther it’s allowed to develop, the more serious, and life-threatening, a condition it becomes.
“Barrett’s Esophagus.” Johns Hopkins Pathology.
“Barrett’s Esophagus.” Mayo Clinic.
“Barrett’s Esophagus: Symptoms, Causes, and Treatments.” WebMD.