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Barrett's Esophagus

Definition

The esophagus is a tube that carries food from your mouth to your stomach. Chronic esophagitis is inflammation of the esophagus. Barrett's esophagus is a complication of chronic esophagitis.
Barrett's esophagus is a change in the cells that line the esophagus. Normal cells are flat-shaped squamous cells. Barrett's esophagus cells are shaped like a column. This cell change is called metaplasia. It is a premalignant phase that may result in cancer of the esophagus if it is not treated.

Causes

The exact cause of Barrett's esophagus is not known. It may result from damage to the esophagus caused by the chronic reflux of stomach acid. Frequent or chronic reflux of stomach acid into the esophagus is called gastroesophageal reflux disease or GERD.
Gastroesophageal Reflux
Gastroesophageal Reflux
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Risk Factors

Barrett's esophagus is more common in Caucasian men over 40 years old. Other factors that increase your chances of Barrett's esophagus include chronic heartburn or a history of GERD.

Symptoms

In some cases Barrett's esophagus may not produce symptoms.
Some people with GERD may have the following symptoms:
  • Heartburn
  • Regurgitation
  • Sore throat or chronic cough
  • Hoarse voice
  • Sour taste in mouth from acid reflux
More serious symptoms include:
  • Difficulty or pain with swallowing, a condition called dysphagia
  • Weight loss
  • Fatigue, or difficulty or pain with breathing associated with anemia

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. In order to diagnose Barrett's esophagus, your doctor may recommend an upper GI endoscopy with a biopsy.

Treatment

The cell changes from Barrett's esophagus are permanent once they occur. Talk to your doctor about the best treatment options for you. Treatment may include:

Medications

Your doctor may recommend the proton pump inhibitors (PPIs). PPIs help control GERD symptoms and prevent further damage to the esophagus.

Surgery

Your doctor may recommend surgery if the disease is severe or the medication is not helpful. Surgical options may include:
Fundoplication
A part of the upper stomach is wrapped around the esophagus. This is done to reduce further damage caused by GERD.
Esophagectomy
This procedure removes the part of the esophagus that has the Barrett's. The esophagus reconstructed using a part of the stomach or large intestine.
Endoscopic Eradication
Endoscopic eradication destroys the Barrett's cells in the esophagus. Eventually, the body starts making normal esophageal cells where the Barrett's cells used to be. The most common endoscopic eradication procedures include:
  • Photodynamic therapy—uses laser light
  • Radiofrequency ablation—uses radiowaves

Monitoring

Your doctor may recommend endoscopy anywhere from every 3 months to 5 years depending on how abnormal the cells in your esophagus look

Prevention

The best way to prevent Barrett's esophagus is to reduce and/or treat the reflux of stomach acid into the esophagus. This is usually caused by GERD. Self-care measures for GERD include:
  • Do not smoke. If you smoke, quit.
  • If you are overweight, lose weight.
  • Raise the head of your bed onto 4-6 inch blocks.
  • Avoid clothes with tight belts or waistbands.
  • Avoid foods that cause heartburn. These include alcohol, caffeinated beverages, chocolate, and foods that are fatty. This also includes spicy or acidic foods such as citrus or tomatoes.
  • Do not eat or drink for 3-4 hours before you lie down or go to bed.

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

The Society of Thoracic Surgeons http://www.sts.org

CANADIAN RESOURCES

Canadian Society of Intestinal Research http://www.badgut.com

Health Canada http://www.hc-sc.gc.ca

References

Barrett esophagus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 28, 2013. Accessed April 30, 2013.

Barrett's esophagus. National Digestive Diseases Information Clearinghouse website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/barretts. Updated January 22, 2013. Accessed April 30, 2013.

Cameron AJ. Barrett's esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999;94(8):2054-2059.

Pereira-Lima JC, Busnello JV, Saul C. High power setting argon plasma coagulation for the eradication of Barrett's esophagus. Am J Gastroenterol. 2000;95(7):1661-1668.

Rajan E, Burgart LJ, Gostout CJ. Endoscopic and histologic diagnosis of Barrett esophagus. Mayo Clin Proc. 2001;76(2):217-225.

Sampliner RE. Ablative therapies for the columnar-lined esophagus. Gastroenterol Clin North Am. 1997;26(3):685-694.

Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996;44(5):532-535.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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