What is Barrett esophagus?

Related conditions:
Esophageal adenocarcinoma, gastroesophageal reflux disease (GERD), hiatal hernia

Definition:
Barrett esophagus is a condition in which some of the cells lining the esophagus (the tube that carries food to the stomach) are replaced with a different type of cell similar to those lining the intestines, a process called intestinal metaplasia. Rarely, these cells develop into cancer of the esophagus, specifically esophageal adenocarcinoma. This condition is named after Norman Barrett, who first described it in 1957.

Risk factors: Developing Barrett esophagus is linked to chronic heartburn and another common condition called gastroesophageal reflux disease (GERD). However, the chances of heartburn or GERD developing into Barrett esophagus are very small. Sometimes people who develop GERD also have a hiatal hernia, in which part of the stomach bulges through the diaphragm. This kind of hernia may trap acid in the esophagus and cause more damage, eventually leading to GERD and progressing into Barrett esophagus.

Etiology and the disease process: Normally, a round muscle (sphincter) near the bottom of the esophagus keeps stomach acid from washing back up into the esophagus. In people with GERD, some of the acid of the stomach leaks into the esophagus, possibly because of a weakness in the sphincter. In about 10 to 15 percent of these people, the acid changes the color and makeup of the cells lining the esophagus, making them darker than the normal esophagus tissue and more resistant to stomach acid, much like intestinal cells. Rarely, Barrett esophagus cells develop into a precancerous state called dysplasia. In some of these cases, dysplasia then develops into esophageal cancer.

Incidence: According to the National Digestive Diseases Information Clearinghouse, approximately 1.6 to 6.8 percent of people have Barrett esophagus. It is very uncommon in children; the average age of diagnosis is fifty-five. It is twice as common in men as in women. Caucasians and possibly Hispanics are more likely to develop this condition than those of other ethnic backgrounds.

Symptoms: Symptoms include chronic heartburn, chronic acid reflux, trouble swallowing or a feeling that something is stuck in the throat, weight loss, spitting up food, excessive burping, hoarseness, sore throat, and bleeding. Sometimes people with chronic heartburn will get some relief from their symptoms when they develop Barrett esophagus. The intestinal metaplasia may help protect the esophagus from the stomach acid because those cells are normally found in the intestines and are better able to withstand stomach acid.

Screening and diagnosis: Adults over the age of forty who have had chronic heartburn or acid reflux may be screened via endoscopy to see whether they have Barrett esophagus. However, screening for this disease is not commonly recommended, as an endoscopy is expensive and the rate of discovering the condition is very low. People who have no symptoms should not have an endoscopy just to see if they have this condition. Barrett esophagus can be diagnosed only by performing a biopsy on suspected tissue. There is no staging for Barrett esophagus.

Treatment and therapy: Treatment for Barrett esophagus involves avoiding further damage. Therapies that keep the acid in the stomach from moving up into the esophagus may include antacid-type medications or other medications that stop stomach-acid production, such as proton-pump inhibitors. Lifestyle changes, such as losing weight, stopping smoking, avoiding certain foods, and eating more fruits, vegetables, and vitamins, also help. Other ways to keep the acid in the stomach include eating smaller meals more often, wearing loose-fitting clothing, waiting two to three hours after eating before lying down, and elevating the head of the bed eight to ten inches. A type of surgery that reinforces the sphincter that keeps acid in the stomach may also help.

Ablative treatments for removing Barrett esophagus cells include photodynamic therapy, which kills the cells using a photosensitizing chemical called porfimer sodium and a laser, and radiofrequency ablation, which uses radio waves. However, removing the cells has not yet been proved to reduce the risk of developing esophageal cancer. Endoscopic ablation is usually recommended only when a patient has highly developed precancerous or already-cancerous cells.

There is no cure for Barrett esophagus other than surgically removing the esophagus. This type of surgery is only performed on those who have already developed esophageal adenocarcinoma or are at very high risk for developing it. In this surgery, the affected part of the esophagus is removed, and the stomach is brought up and attached to the nonaffected part of the esophagus.

Prognosis, prevention, and outcomes: Barrett esophagus may not cause any problems or symptoms in those who have it. It is only significant because it is a precursor to esophageal adenocarcinoma, but even those who have Barrett esophagus have approximately 0.5 percent chance of developing this type of cancer. Those who have been diagnosed with Barrett esophagus should be screened regularly, every one to three years, to ensure that the cells are not developing into cancer.

Some ways of attempting to prevent further damage to the esophagus are to eat a diet low in fat and high in fruits, vegetables, and fiber. Avoiding smoking and maintaining a healthy weight may also help.

Badash, Michelle. "Barrett's Esophagus." Rev. Daus Mahnke. Health Library. EBSCO, 7 May 2014. Web. 5 Sept. 2014.

"Barrett's Esophagus." Rev. G. Richard Locke and Joel Richter. National Digestive Diseases Information Clearinghouse. Natl. Insts. of Health, 20 Nov. 2013. Web. 4 Sept. 2014.

Falk, Gary W. "Barrett's Esophagus." The Esophagus. Ed. Joel E. Richter and Donald O. Castell. 5th ed. Malden: Blackwell, 2012. 509–39. Print.

Madell, Robin, and George Krucik. "Barrett's Esophagus and Acid Reflux." Healthline. Healthline Networks, 30 June 2012. Web. 4 Sept. 2014.

Owens, Scott R., and Henry D. Appelman. Atlas of Esophagus and Stomach Pathology. New York: Springer, 2014. Print.

Parker, James, and Philip M. Parker, eds. The Official Patient’s Sourcebook on Barrett’s Esophagus: A Revised and Updated Directory for the Internet Age. San Diego: Icon, 2002. Print.

Polsdorfer, Ricker. "Cancer InDepth: Esophageal Cancer." Rev. Mohei Abouzied. Health Library. EBSCO, 27 May 2014. Web. 5 Sept. 2014.

Shalauta, Saad R. “Barrett’s Esophagus.” American Family Physician 69.9 (2004): 2113–18. Print.

Sharma, Prateek, and Richard E. Sampliner, eds. Barrett’s Esophagus and Esophageal Adenocarcinoma. 2nd ed. Malden: Blackwell, 2006. Print.