Barrett's Esophagus

What is Barrett's Esophagus?

Barrett's esophagus (also called Barrett's syndrome and Columnar Epithelium Lined Lower Oesophagus [CELLO]) is a condition in which the surface of the esophagus contacts with stomach acids, which in turn, cause tissue injury and chronic inflammation. After frequent exposure to stomach acids, the normal cells of the esophagus wall undergo changes in gene expression that lead to an abnormality characterized by the presence of intestinal-like cells. These abnormal cells are the hallmark of Barrett's esophagus.

Barrett's esophagus develops frequently as a consequence of continued gastroesophageal reflux disease (GERD), a condition characterized by constant regurgitation of acid from the stomach into the lower esophagus. People suffering from Barrett's esophagus have an increased risk of developing esophageal cancer (adenocarcinoma).

Barrett's esophagus is more common in older adults who are more than 50 years old, but it can occur at any age. The risk of developing Barrett's esophagus is greater in White and Hispanic people (compared to African-Americans), and it is more common in men.

What Causes Barrett's Esophagus?

The precise cause and pathological mechanism of Barrett's esophagus is unknown. The condition is strongly associated with chronic exposure to stomach acid and long term GERD. The acid causes damage to epithelial cells, such as the ones lining the esophagus. It is thought that prolonged exposure to injury triggers changes that lead to the cellular abnormalities that are a characteristic of this condition. However, a small fraction of patients diagnosed with Barrett's Esophagus have never experienced heartburn or acid reflux.

Symptoms of Barrett's Esophagus

Barrett's esophagus has no specific symptoms. Some patients do not display any symptoms. The relevant symptoms experienced by people with Barrett's Esophagus are normally related to GERD:

• Heartburn
• Difficulty in Swallowing (dysphagia)
• Vomiting Blood
• Chest Pain
• Weight Loss
• Black, Tarry Stools

Diagnosis of Barrett's Esophagus

Diagnosis requires direct observation of altered cell morphology in the esophageal wall. This can be performed by endoscopy, and if necessary, by laboratory testing of a sample esophageal tissue.

During the endoscopy, a thin tube with a camera (an endoscope) is inserted through the mouth and passed into the esophagus and stomach. Using this method, the physician can inspect the esophagus visually and may remove a small sample of tissue for biopsy to confirm the diagnosis and to evaluate the risk of developing cancer.

Treatment of Barrett's Esophagus

In cases where the risk of cancer is low, treatment is aimed to manage and control acid reflux through lifestyle changes and medication.

The following steps should be taken to reduce reflux:

• Avoid lying down after a meal.
• Avoid chocolate, greasy and/or spicy foods, caffeine and peppermint.
• Avoid alcohol and smoking.
• Adopt a sleep position in which the upper body is elevated relative to the torso.
• Keep a healthy weight.
• Avoid pressure on the stomach.

Your doctor might prescribe medication to reduce acid reflux, such as:

• Antacids – neutralize acid.
• Proton pump inhibitors – decrease the production of stomach acid.
• Histamine H2 receptor blockers – minimize the release of stomach acid.
• Promotility agents – drugs that accelerate the progress of food from the stomach to the intestines.

In cases where the risk of developing cancer is elevated, surgical extraction of the highly abnormal (precancerous) cells are recommended. These following procedures may be considered:

• Photodynamic therapy (PDT) – light-sensitive cells are destroyed using a laser device (esophageal balloon). Photofrin is used prior to laser intervention to induce light-sensitivity in the target cells.
• Esophagectomy – surgery to remove the esophagus followed by attachment of the stomach to the remaining esophageal portion.
• Endoscopic mucosal resection (EMR) – surgery to remove areas of damaged cells using an endoscope.

Alternative Treatment

People with Barrett's esophagus normally suffer from GERD. It is important to reduce GERD through regular exercise, healthy diet and by avoiding agents that stimulate the production of stomach acid.

Prognosis of Barrett's Esophagus

People with Barrett's esophagus are more likely to develop esophageal cancer. For this reason, patients should have frequent endoscopic exams to monitor the status of the abnormal tissue. Although the risk of adenocarcinoma of the esophagus is higher, only a very small fraction of people with Barrett's esophagus actually develop cancer.

Keeping GERD under control is an important factor in the long-term prognosis of Barrett's esophagus.

Preventing Barrett's Esophagus

Since most cases are associated with ongoing acid reflux, managing GERD and avoiding acid reflux reduces the risk of Barrett's esophagus. Some cases, however, are not apparently related to GERD, which indicates that other factors might be involved.

Living with Barrett's Esophagus

Barrett's esophagus is considered a precancerous condition and it should be closely monitored. This involves regular visits to the doctor and frequent exams to the surface of the esophagus. It is treatable, as long as you take the medications, go to all of your appointments and also implement the recommended lifestyle changes.

Current Research of Barrett's Esophagus

Current research on Barrett's esophagus is aimed at development of new (non-endoscopic) and improved diagnostic tests as well as new methods for the surgical removal of precancerous cells - such as the new HALO system. Research efforts are also being developed to better characterize the condition at the genetic and molecular levels.