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Barrett’s Esophagus - Epidemiology, Clinical Manifestations, and Diagnosis.

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Barrett's esophagus is a precancerous condition in which the tissues of the lower esophagus become cancerous. This article discusses Barrett's esophagus.

Written by

Dr. Anahita Ali

Medically reviewed by

Dr. Vasavada Bhavin Bhupendra

Published At December 27, 2022
Reviewed AtJuly 3, 2023

Introduction:

Hydrochloric acid is naturally present in the human stomach that helps in digesting food. The stomach juices and acid, commonly called gastric acid, is made of hydrochloric acid. The wall of the stomach has special glands that secrete hydrochloric acid. It is highly acidic and has a pH between 1 to 3.

Sometimes, the gastric acid reversely flows into the esophagus (food pipe) from the stomach. This causes a burning sensation in the chest of the patient and regurgitation. It is called gastroesophageal reflux and is a common condition among people. However, not every patient represents the symptoms of gastroesophageal reflux. Still, those with a history of long-standing gastroesophageal reflux are more likely to develop Barrett's esophagus, characterized by a burning sensation in the chest.

What Is Barrett's Esophagus?

It is a precancerous condition in which the lower esophagus or food pipe lining becomes abnormal. Generally, these tissues are replaced with cancerous tissues.

What Is the Epidemiology of Barrett's Esophagus

The primary cause of Barrett's esophagus is long-standing or chronic gastroesophageal reflux (GERD). Gastroesophageal reflux is a common condition in up to 40% of the population. Barrett's esophagus is seen in 1.6 % of the general population, while 5 % to 15 % of people with gastroesophageal reflux develop Barrett's esophagus. Men are more commonly affected than women and children.

What Causes Barrett's Esophagus?

The exact cause of Barrett's esophagus is unknown, but according to the experts, the primary reason is long-standing or chronic gastroesophageal reflux (GERD).

What Is Gastroesophageal Reflux?

The backward or reverse flow of stomach juice and acid (bile) into the lower part of the esophagus is gastroesophageal reflux.

What Is the Pathophysiology of Barrett's Esophagus?

The esophagus is made of epithelial cells. The exact pathogenesis of Barrett's esophagus is unclear. However, based on various research studies, it is proposed that these cells start secreting inflammatory cytokines that promote inflammation upon continuous exposure to the acidic environment due to gastroesophageal reflux. In 90% of patients with Barrett's esophagus, the cells undergo constant genetic changes. These changes result in the development of a cancerous or malignant condition. After undergoing mutations, the normal squamous epithelial cells become metaplastic columnar epithelial cells.

What Are the Clinical Manifestations of Barrett's Esophagus?

The patient is presented with the following symptoms:

  • Burning of the chest, which is also called heartburn. It is most commonly reported.

  • Acid regurgitation, also called gastroesophageal reflux.

  • Difficulty swallowing.

  • Feeling of obstruction in the throat.

How Is the Diagnosis of Barrett's Esophagus Made?

  1. Patient’s History: Various risk factors are associated with Barrett's esophagus. These risk factors include the patient's age (generally above 50 years), smoking habit, history of gastroesophageal reflux for less than five years, family history of Barrett's esophagus, and obesity. The gender of the patient is also an important factor because it is more prevalent in men than women.

  2. Imaging Tests: Endoscopy of the esophagus shows light pink-colored tissues. An endoscope (a thin, long tube with a camera and light) is inserted into the patient's esophagus to perform an endoscopy.

  3. Capsule Endoscopy: Sometimes, the patient is asked to swallow a pill-size tiny camera to perform the endoscopy. The camera takes images of the internal structures and then naturally passes through the patient’s body through the anus.

  4. Biopsy: A biopsy (a sample of affected or diseased tissue taken and studied under a microscope) of the affected tissues to confirm the diagnosis. The biopsy evaluation may show goblet cells. However, there are two schools of thought on the biopsy. According to one, a biopsy test to detect goblet cells is not required to confirm Barrett's esophagus. According to another, it is important to identify goblet cells to confirm the diagnosis.

What Is the Treatment of Barrett's Esophagus?

The recommended treatment options are mentioned below:

  1. Surveillance Endoscopy: Monitoring the condition through endoscopy is helpful in routine surveillance. Nowadays, a high-definition, white light endoscopy is used for this purpose. The regular examination is done every two to three years. Initially, Barrett's esophagus is not treated, but if the symptoms of gastroesophageal reflux are present, those are treated through medications.

  2. Endoscopic Ablative Therapy: It is performed in patients with dysplasia (a precancerous condition that shows the presence of cancerous or abnormal cells). It is of three types:

  • High Grade - The changes occur in most healthy or normal cells.

  • Low Grade - The changes occur in a few cells.

  • Indefinite for Dysplasia - The changes in the cells do not reveal the cause, such as dysplasia.

If dysplasia is confirmed, endoscopic ablative therapy is performed in which cold or heat energy is used to destroy the abnormal tissues in the esophagus. Patients with low-grade dysplasia can also have a 12-month endoscopic surveillance program.

  1. Cryotherapy: Cryotherapy is also called cold therapy, in which the abnormal tissues are removed at extremely low or freezing temperatures. It is a minimally invasive procedure.

  2. Esophagectomy: Esophagectomy is the surgical removal of the complete esophagus or a diseased part of the esophagus. Generally, it is not the first line of treatment and is considered only for high-grade dysplasia.

What Is the Differential Diagnosis of Barrett’s Esophagus?

The symptoms of Barrett's esophagus may mimic other conditions, such as:

Gastritis:

It is the inflammation of the stomach that can be short-term or long-term (acute or chronic).

  • Obstruction of the Gastric Outlet: It is called antral web cholelithiasis.

  • Coronary Artery Atherosclerosis: It is the narrowing of blood vessels of the heart.

  • Cancer of the Esophagus: Cancer of the food pipe that runs from the throat to the stomach.

  • Motility Disorder of the Esophagus: It causes difficulty swallowing because of any health condition or disease.

  • Spasm of the Esophagus: It is the painful contraction of the esophagus muscles.

Esophagitis:

It is the inflammation of the esophagus.

  • Stones in the gallbladder.

Conclusion:

Barrett's esophagus is a slow-progressing cancerous condition. The primary cause of Barrett's esophagus is gastroesophageal reflux, the backward or reverse flow of stomach juice and acid (bile) into the lower part of the esophagus. Men are more commonly affected than women and children because of their smoking habits. Other risk factors include a history of gastroesophageal reflux from the past five years, obesity, and family history. Heartburn or a burning sensation in the chest is the primary symptom. There is no definitive treatment for Barrett's esophagus; however, surveillance or monitoring of the condition can help detect and prevent cancer.

Frequently Asked Questions

1.

What Is the Seriousness of Barrett’s Esophagus?

Barrett's esophagus is a condition that should be taken seriously due to its potential complications and implications. The severity of Barrett's esophagus can vary from person to person. Barrett's esophagus itself is considered a precancerous condition. Individuals with Barrett's esophagus are at an increased risk of developing esophageal adenocarcinoma, a type of cancer.

2.

Is Barrett’s Esophagus Curable?

Barrett's esophagus itself is not a condition that can be completely cured. However, some treatment options, such as surveillance endoscopy for regular monitoring, endoscopic ablative therapy for dysplasia (precancerous changes), cryotherapy, and, in certain cases, esophagectomy (surgical removal of part or all of the esophagus), can help reduce the risk of cancer development and improve long-term outcomes.

3.

Is Barrett’s Esophagus a Form of Cancer?

No, Barrett’s esophagus is not a form of cancer. Barrett's esophagus is a precancerous condition associated with an elevated risk of developing esophageal cancer. Although the majority of individuals with Barrett's esophagus do not develop cancer, regular monitoring is essential to detect any potential progression of the condition.

4.

Can Barrett’s Esophagus Heal Naturally?

No, Barrett's esophagus cannot be naturally healed without medical intervention. Certain lifestyle changes like managing gastroesophageal reflux disease (GERD) symptoms, adopting a healthy diet, and avoiding tobacco and alcohol may help alleviate symptoms, but they do not reverse the underlying changes in the esophageal lining. Medical management, surveillance, and treatment are necessary for managing Barrett's esophagus and reducing the risk of progression to esophageal cancer.

5.

Which Medicine Is Best for Treating Barrett’s Esophagus?

There is no specific "best" medicine for Barrett's esophagus. The primary goal of medication in managing Barrett's esophagus is to control gastroesophageal reflux disease (GERD) and reduce symptoms. Proton pump inhibitors (PPIs) such as Omeprazole, Lansoprazole, and Pantoprazole are commonly prescribed to decrease acid production and alleviate reflux symptoms.

6.

Is It Possible to Lead a Normal Life With Barrett’s Esophagus?

Yes, it is possible to lead a normal life with Barrett's esophagus. With proper management, regular monitoring, and adherence to recommended treatment strategies, individuals with Barrett's esophagus can live fulfilling lives. Make necessary lifestyle modifications, and attend regular check-ups to reduce the risk of possible complications and ensure optimal health.

7.

What Does Barrett’s Esophagus Stage 4 Mean?

Stage 4 Barrett’s esophagus represents high-grade dysplasia. In high-grade dysplasia, more significant and severe abnormal cell changes in the esophageal tissue are observed. High-grade dysplasia is considered a precancerous condition with a higher risk of progressing to invasive cancer.

8.

Does Vitamin C Benefit Barrett’s Esophagus?

According to a recent study, dietary supplementation with vitamin C has shown the potential to decrease the activity of proinflammatory markers and related cytokines associated with the progression to cancer in individuals with Barrett's esophagus. However, further studies need to be done in order to understand the extent of vitamin C's impact on Barrett's esophagus and its potential as a preventive or therapeutic measure.

9.

Can Cancer Gerd Be Cured?

GERD (gastroesophageal reflux disease) itself is not cancer, but GERD can increase the potential of developing certain types of esophageal cancer, such as esophageal adenocarcinoma. The curability of GERD-related cancer depends on various factors, such as the stage at which the cancer was diagnosed and the individual's response to treatment. Early-stage esophageal cancer can potentially be cured. However, as cancer progresses to advanced stages, the chances of a complete cure decrease.

10.

Is Turmeric Beneficial for Barrett’s Esophagus?

Some studies suggest that curcumin, the active compound in turmeric, may have potential benefits for individuals with Barrett's esophagus. It exhibits anti-inflammatory and antioxidant properties that could reduce inflammation and oxidative stress in the esophageal tissues. Furthermore, the anticancer property may hinder the progression of Barrett's esophagus to esophageal adenocarcinoma. However, further research and clinical trials are necessary to fully understand the therapeutic value of turmeric in treating Barrett's esophagus.

11.

Will Gerd Persist Throughout Life?

Yes, GERD (gastroesophageal reflux disease) is generally considered a chronic condition that can persist for a person's lifetime. While the severity and frequency of symptoms may vary over time and can be managed with appropriate treatment and lifestyle modifications, GERD will require continued treatment to control the symptoms and minimize complications.

12.

At What Age Does Esophageal Cancer Commonly Occur?

Esophageal cancer commonly occurs in individuals who are 50 years old or older. However, esophageal cancer has been reported in individuals of younger age groups. Various factors such as lifestyle (smoking and alcohol consumption), genetics, and underlying medical conditions influence the risk and age of onset for esophageal cancer.

13.

Can One Completely Recover From Esophageal Cancer?

The chances of full recovery from esophageal cancer will depend on the stage at which the cancer was diagnosed, as well as the individual's overall health. Early-stage esophageal cancer has a higher likelihood of being cured with treatment, while advanced-stage cancer may be slightly more difficult to manage and may have a lower chance of complete recovery.

14.

Can Esophageal Cancer in Stage 2 Be Cured?

Esophageal cancer in stage 2 can potentially be cured. Depending on various factors, including the specific characteristics (such as size and location) of the cancer and the individual's response to treatment, the prognosis may vary among individuals. Treatment options, such as surgery, chemotherapy, radiation therapy, and targeted therapies, are available to improve the chances of a favorable outcome.

15.

How to Confirm Esophageal Cancer?

A flexible tube with a video lens (endoscope) is inserted through the throat into the esophagus to visually examine the esophageal lining. This allows for the detection of cancerous areas or areas of irritation. During an endoscopy, a sample of suspicious tissue is collected using specialized tools. This collected sample of tissue is then sent to a laboratory for analysis, where the presence of cancer cells can be confirmed.

16.

What Are the Symptoms of Esophageal Cancer?

Some common signs and symptoms of esophageal cancer may include:
- Difficulty or pain when swallowing (dysphagia).
- Persistent or worsening heartburn or indigestion.
- Unexplained weight loss.
- Chest pain or discomfort.
- Chronic cough or hoarseness.
- Regurgitation of food or sour liquid.
- Fatigue or weakness.

17.

Is Esophageal Cancer Visible on a Chest X-Ray?

A chest X-ray is generally not considered a reliable method for detecting esophageal cancer. However, a barium swallow study can be conducted to visualize the esophagus and identify any abnormalities or changes in the esophageal tissue. This procedure involves swallowing a liquid containing barium, which allows for better visibility of the esophagus during subsequent X-rays.

18.

Can Esophageal Cancer Be Detected in CT Scan?

Yes, a CT (computed tomography) scan is a commonly used imaging test that can detect esophageal cancer. It provides detailed cross-sectional images of the esophagus and surrounding structures to help identify any abnormalities, tumors, or changes in the esophageal tissue and play a crucial role in staging the disease and planning appropriate treatment strategies.
Dr. Vasavada Bhavin Bhupendra
Dr. Vasavada Bhavin Bhupendra

Surgical Gastroenterology

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