Barrett's esophagus is a condition in which the normal lining of the tube connecting the mouth and stomach is replaced with different tissue. The different tissue is similar to the tissue that lines the intestine. This tissue replacement is referred to as intestinal metaplasia.
The cause of this rare condition is not entirely known and it only affects approximately 1.6 to 3 percent of people.
People with Barrett's esophagus are at a slightly increased risk of developing esophageal adenocarcinoma, a rare form of cancer that affects the tube connecting the mouth and stomach known as the esophagus.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this cancer affects 0.5 percent of people with Barrett's esophagus each year.
Barrett's esophagus is most commonly seen in individuals with long-term gastroesophageal reflux disease (GERD). GERD is a disease where stomach acid escapes the stomach and causes pain in the esophagus.
Here are some key points about Barrett's esophagus. More detail and supporting information can be found in the main article.
- Barrett's esophagus is most commonly seen in people who have had GERD for a long time.
- There are no symptoms associated with the change in tissue associated with Barrett's esophagus.
- People who are diagnosed with the condition will experience the symptoms of GERD such as chest pain.
- People with Barrett's esophagus are at a slightly higher risk of developing a type of cancer compared with other people.
- The tissue changes linked to Barrett's esophagus can be treated with surgery.
Causes and risk factors of Barrett's esophagus
As with most diseases and conditions, there are certain groups of people who are at a higher risk of developing Barrett's esophagus.
GERD is a condition that is closely linked to Barrett's esophagus.
The NIDDK state that between 5 and 10 percent of people with GERD develop Barrett's esophagus.
People who are at an increased risk include:
- Overweight and obese people
- People with long-term GERD for more than 5 years
- People with GERD who are over 50 and need to use medication regularly
People who are under the age of 30 when their chronic GERD begins may also be at an increased risk.
According to the NIDDK, males develop Barrett's esophagus twice as often as females. Caucasian males are also more likely to develop Barrett's esophagus than other males.
There are also several factors that could reduce the risk of Barrett's esophagus. The NIDDK suggest the following factors:
- Having an infection caused by bacteria known as Helicobacter pylori
- Frequently using aspirin or other anti-inflammatory drugs
- Following a diet that is high in fruit, vegetables, and certain vitamins
Symptoms of Barrett's esophagus
However, many people who are diagnosed with the condition also experience the symptoms of GERD. These symptoms include:
- Heartburn - a burning sensation in the chest
- Difficulty swallowing food
- Chest pain
The majority of people who are diagnosed with Barrett's esophagus do not experience any symptoms at all.
Tests and diagnosis of Barrett's esophagus
According to the NIDDK, the average age of diagnosis for Barrett's esophagus is 55 years of age.
An endoscope is a tool that doctors use to examine the inside of the esophagus, stomach, and intestine.
To diagnose Barrett's esophagus, healthcare providers may recommend that patients undergo an examination of their esophagus, stomach, and intestine. A tissue sample known as a biopsy may be taken at the same time.
This examination is known as an endoscopy, and it is usually performed under light sedation.
An endoscopy uses a tool with a camera called an endoscope to look inside the body. It is used to work out if the tissue in the esophagus has changed and to obtain a biopsy of the esophagus lining.
It is difficult for doctors to take a biopsy that is representative of the lining of the esophagus. Not all areas of the esophagus are affected by Barrett's esophagus. As a result, the doctor will typically take at least eight biopsies during the procedure.
Normal tissue appears different to tissue affected by Barrett's esophagus. Normal tissue appears pale and glossy while tissue affected by Barrett's esophagus is red and velvety.
Treatment of Barrett's esophagus
Treatment of Barrett's esophagus depends on how severe the tissue change is, as well as the patient's overall health.
Treatments for no or mild tissue changes
- A follow-up endoscopy after 1 year, followed by one every 3 years (for people with no tissue changes)
- A follow-up endoscopy in 6 months to 1 year (for people with mild tissue changes)
- Medication to treat the symptoms of GERD
- Possible surgery to tighten the muscle in the stomach that stops stomach acid from escaping
Barrett's esophagus is not treated by treating the symptoms of GERD. However, GERD treatments make it easier for doctors to detect tissue changes.
Treatments for more severe tissue changes
- Endoscopic resection: removal of abnormal cells using a tool called an endoscope.
- Radiofrequency ablation: the removal of abnormal tissue in the esophagus with heat-causing radio waves.
- Cryotherapy: the application of cold liquid or gas to abnormal cells in a cycle of freezing and thawing that causes damage to tissue.
- Photodynamic therapy: the process of making abnormal cells sensitive to light with the use of a light-activated chemical called profimer. A laser is then used to destroy these cells.
- Endoscopic mucosal resection: removal of the Barrett's tissue by lifting and removing it with an endoscope. At times, this may be used in combination with photodynamic therapy.
- Esophagectomy: the removal of the abnormal areas of the esophagus. The esophagus is then rebuilt by using parts of the stomach or small intestine.
Medications may be recommended by a healthcare provider to treat GERD. These medications include a class of drugs known as proton pump inhibitors.
Examples of proton pump inhibitors include omeprazole, lansoprazole, and esomeprazole.
Certain lifestyle changes can also be made to reduce the symptoms of GERD:
- Maintaining a healthy weight
- Avoiding tight-fitting clothes
- Giving up smoking
- Avoiding of stooping, bending, or lying down after eating
- Raising the head of the bed by 6 to 8 inches by placing wooden blocks under the bed
Greasy and fatty foods can trigger the symptoms of GERD.
Some kinds of food and drink can trigger GERD. People who eliminate them from their diets can reduce their GERD symptoms.
Food and drinks that can trigger GERD include:
- Fatty foods
- Greasy foods
- Spicy foods
- Tomatoes and tomato-based products
Eating small, frequent meals instead of three large meals can also help reduce the symptoms of GERD.
People who experience the symptoms of GERD or have questions about their risk of Barrett's esophagus should speak with their healthcare provider.