Barrett’s Esophagus

What is Barrett’s Esophagus?

Barrett’s Esophagus is a pre-cancerous condition of the esophagus. The esophagus is the tube that connects the mouth to the stomach. In Barrett’s Esophagus, the lining of the lower esophagus change in form to look more like the lining of the stomach. This change happens due to years of cell injury from acid reflux into the esophagus from the stomach. The change in the cell lining is a defense mechanism against acid injury because the cells that line the stomach are more resistant to acid injury. Unfortunately, these new cells have a risk of becoming cancerous due to the repeated injury from the acid.

Who is at risk?

Anyone with a long history of heartburn symptoms or GastroEsophageal Reflux Disease (GERD). It is more common in men than in women. It is also more common in people of Caucasian descent, but can occur in any ethnicity. People who smoke are at higher risk than non-smokers.

What are the symptoms?

There are usually no symptoms from the change in the cell lining in Barrett’s Esophagus. Most people diagnosed with Barrett’s Esophagus usually present to their doctor due to symptoms of heartburn, acid reflux or trouble swallowing.

How is it diagnosed?

If you have symptoms of GERD with any risk factors, a gastroenterologist can perform an upper endoscopy. An upper endoscopy is a procedure performed to look inside your esophagus to determine if you have the changes of Barrett’s Esophagus. It is a painless procedure and requires sedation. If necessary, a small piece of the abnormal tissue can be taken (a biopsy) so that it can be studied under a microscope to confirm the diagnosis.

How is it treated?

The most important form of treatment and prevention is to change your diet to avoid foods that cause acid reflux and its symptoms. Common foods to avoid are tomato-based foods and sauces, citric juices, coffee, caffeine, chocolate, alcohol and foods high in fat. Changes in lifestyle are also important. Such changes are to quit smoking, eat smaller meals and not to lie down soon after eating a meal.

The use of medications to reduce acid production from the stomach can also help decrease the injury to the lining of the esophagus. Some of these medications are available without a prescription, but you should still consult a gastroenterologist about their use. In select cases where medications do not help, there may be some surgical procedures than can help.

You may require surveillance of the abnormal lining with periodic upper endoscopy and repeat biopsy.   If pre-cancerous changes are detected on biopsy during endoscopy, then it may be possible to remove or destroy the abnormal tissue during an upper endoscopy. This form of treatment should only be performed by gastroenterologist who has experience with it and performs the treatment regularly.

Summary

Barrett’s Esophagus is a chronic, pre-cancerous condition of the esophagus caused by repeated injury to the lower esophagus from acid reflux. It is diagnosed by upper endoscopy and, if present, should be treated early to prevent the formation of esophageal cancer. If you have a long history of heartburn, acid reflux, trouble swallowing or any of the risk factors listed above, please talk to your primary care physician or get referred to a Gastroenterologist to discuss your risk for Barrett’s Esophagus.

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