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:
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Burning of the chest, which is also called heartburn. It is most commonly reported.
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Acid regurgitation, also called gastroesophageal reflux.
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Difficulty swallowing.
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Feeling of obstruction in the throat.
How Is the Diagnosis of Barrett's Esophagus Made?
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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.
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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.
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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.
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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:
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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.
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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:
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High Grade - The changes occur in most healthy or normal cells.
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Low Grade - The changes occur in a few cells.
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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.
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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.
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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).
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Obstruction of the Gastric Outlet: It is called antral web cholelithiasis.
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Coronary Artery Atherosclerosis: It is the narrowing of blood vessels of the heart.
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Cancer of the Esophagus: Cancer of the food pipe that runs from the throat to the stomach.
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Motility Disorder of the Esophagus: It causes difficulty swallowing because of any health condition or disease.
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Spasm of the Esophagus: It is the painful contraction of the esophagus muscles.
Esophagitis:
It is the inflammation of the esophagus.
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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.
