Gastro-esophageal reflux disease (GERD) is a condition where a person regularly regurgitates stomach acid and other chemicals into the esophagus. In the short term, this causes the discomfort of heartburn. But over the long term, it has the potential to cause something much more serious.
People suffering from chronic GERD are advised to be examined by their doctor. If chronic GERD is left untreated long enough, especially in white males over the age of 50, it can give rise to a precancerous condition called Barrett’s esophagus.
Barrett’s esophagus is a response of the body to the constant irritation of the esophageal lining by chemicals that it’s not suited to handle. In an estimated 10%-15% of people with chronic acid reflux, the esophagus doesn’t rebuild its damaged areas with its normal squamous type cells, but by developing intestinal type cells better equipped to protect against these chemicals. When cells develop out of their usual location in the body like this, it’s called metaplasia.
Often people will experience a lessening of their heartburn discomfort as a result of Barrett’s esophagus, since the esophagus is now better protected. However, developing these intestinal type cells out of place is highly correlated with 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 intestinal type cells in the esophagus are more prone to something called dysplasia, which is abnormal development of cells, generally a delayed maturation that results in a disproportionate amount of immature cells. This in itself is not cancerous, but the greater the dysplasia, the more likely cancer is to develop.
If Barrett’s esophagus is caught early, cancer can usually be prevented or cured. But once the esophageal cancer has developed and spread, it reaches a point where it is incurable. That’s why it’s so important to stay on top of GERD and monitor if Barrett’s esophagus has developed.
The diagnostic tool used to check for Barrett’s esophagus is the endoscope, which 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 taken to be examined under a microscope to determine the presence of Barrett’s esophagus.
In cases of Barrett’s esophagus where little or no dysplasia is yet evident, the doctor will treat the acid reflux and monitor the situation with follow up endoscopies.
There are many antireflux therapies that a doctor might recommend, including 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, to lose weight, and to reduce their frequency of consumption of large or high-fat meals, alcohol, caffeine, chocolate, nicotine, peppermint, and raw onions.
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 called for. First, 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, the treatment options include certain forms of ablation, such as radiofrequency ablation. This involves inserting a balloon filled with electrodes into the esophagus, where it 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, which causes light-sensitive cells to accumulate in the lining of the esophagus. Laser light is then directed at these cells to cause them to produce cytotoxic oxygen free radicals to kill nearby cells.
Another option is endoscopic surgery, where small surgical tools are passed down through the endoscope and used to resect the damaged cells.
If the problem cells cannot be successfully eliminated through any of these means, it is also possible to surgically remove the damaged part of the esophagus. The remaining esophagus is then surgically reattached to the stomach.
Once cancer of the esophagus has developed, in addition to surgery, chemotherapy and radiation are also possible treatments. But the goal is to head it off long before it reaches this stage, by monitoring and treating GERD so that Barrett’s esophagus doesn’t lead to cancer.
“Barrett’s Esophagus.” Johns Hopkins Pathology.
“Barrett’s Esophagus.” Mayo Clinic.
“Barrett’s Esophagus: Symptoms, Causes, and Treatments.” WebMD.