Introduction:
The esophagus is the tube that carries food from the mouth to the stomach. In Barrett's esophagus, normal tissue cells lining the esophagus change like intestine cells. It is more common in people with gastroesophageal reflux disease (GERD). As a result, Barrett's has an increased risk of developing esophageal cancer. The condition is named after the surgeon Norman Barrett.
What Causes Barrett's Esophagus?
The exact cause of Barrett's esophagus is not known. However, this condition is often seen in gastroesophageal reflux disease (GERD) patients. It occurs when the lower esophageal sphincter muscle weakens or is damaged and does not prevent the stomach acid from back flowing into the esophagus. Barrett's esophagus can also develop without gastroesophageal reflux disease. Approximately five to ten percent of the people with GERD develop Barrett's esophagus. It affects men twice more than women.
Who Is at Risk for Barrett's Esophagus?
People who are more likely to develop Barrett's esophagus are:
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Male are more likely to be affected.
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Middle-aged and older adults are at high risk.
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Obese people.
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Family history of Barrett's esophagus or esophageal cancer.
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Gastroesophageal reflux disease (GERD).
Factors aggravating gastroesophageal reflux disease (GERD) can worsen Barrett's esophagus. Those include:
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Frequent use of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.
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Eating large portions of food.
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Fatty food.
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Spicy food.
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Going to bed immediately after eating.
What Are the Symptoms of Barrett's Esophagus?
Barrett's esophagus does not show any symptoms. However, heartburn and acid reflux are the symptoms that can signal Barrett's esophagus.
Other symptoms include:
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Heartburn that worsens or wakes you from sleep.
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A sensation of food stuck in the esophagus.
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Painful or difficult swallowing.
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Unexplained weight loss.
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Blood in stool.
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Vomiting.
How Is Barrett's Esophagus Diagnosed?
The only way to confirm the diagnosis of Barrett's esophagus is with an upper endoscopy.
This involves inserting a thin, flexible tube attached to a camera through the throat into the esophagus. The endoscope is used to look for changes in the esophagus lining. Normal esophagus lining appears pale and glossy, whereas the tissue appears red and velvety in Barrett's esophagus. The diagnosis is confirmed by taking tissue samples (biopsy) from the lining of the esophagus and analyzed in the laboratory. The tissue is examined to determine the degree of change.
Determining the Degree of Tissue Change:
The tissue change is classified as:
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No Dysplasia: No precancerous changes are found in the cells.
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Low-Grade Dysplasia: Small signs of precancerous changes.
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High-Grade Dysplasia: Cells show many changes. High-grade dysplasia can change into esophageal cancer.
What Is the Anatomy and Histology of Barrett's Esophagus?
The esophagus is normally lined by stratified squamous epithelium. Barrett's esophagus results from a metaplastic conversion of the normal squamous epithelium of the esophagus to columnar epithelium with goblet cells.
What Is the Screening for Barrett's Esophagus?
Screening is recommended for men who have gastroesophageal reflux symptoms that do not respond to medications like proton pump inhibitors and who have at least two more risk factors, including:
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Being male.
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Being white.
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Being over 50 years of age.
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Having a family history of Barrett's esophagus or esophageal cancer.
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Being a current or past smoker.
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Obese.
What Is the Treatment of Barrett's Esophagus?
The treatment depends upon the symptoms and dysplasia on biopsies.
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Barrett's Esophagus Without Dysplasia:
Barrett's esophagus without dysplasia means precancerous cells are absent. Usually, no treatment is needed at this stage therefore, continuous monitoring with an upper endoscopy is followed. Upper endoscopy is done every two or three years to look for changes in the lining cells. If gastroesophageal reflux disease (GERD) is present, medications are prescribed to treat the symptoms. Medications include H2 receptor antagonists and proton pump inhibitors. These medications decrease stomach acid. Lifestyle changes can also help in relieving the symptoms. For example, eating meals at regular intervals, dinner two hours before bed, and sleeping in a slightly inclined position can also help.
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Barrett's Esophagus With Dysplasia:
Dysplasia is the presence of cancerous cells. Therefore, frequent monitoring is followed to prevent cancer from developing.
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Low-Grade Dysplasia: Low-grade dysplasia indicates the presence of some abnormal cells. Frequent monitoring and follow-up are needed in these cases. Upper endoscopy is done every six months to a year. Ablation therapy is also recommended in some patients.
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High-Grade Dysplasia: High-grade dysplasia indicates the presence of abnormal cells in the esophagus lining. Cancer is highly associated in these cases. Upper endoscopies are repeated more often to look for cancer.
The treatment for removing the damaged tissue includes:
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Radiofrequency Ablation: This is the most common procedure. It kills the abnormal tissue using radio waves which generate heat.
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Cryotherapy: Liquid nitrogen is used to freeze the damaged tissues of the esophageal lining.
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Photodynamic Therapy: This uses light to destroy precancerous cells. First, the cells are sensitized with medication and then exposed to light using an endoscope.
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Endoscopic Mucosal Resection: Precancerous spots on the esophageal lining are removed using an endoscope.
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Surgery: Esophagectomy is surgery to remove all or part of the esophagus; it is done in severe dysplasia or esophageal cancer cases.
What Are the Complications?
Possible complications of these procedures include narrowing of the esophagus, cuts or rupture in the esophagus, and chest pain.
How to Prevent Barrett's Esophagus?
People with untreated heartburn are more likely to develop Barrett's esophagus. In addition, untreated heartburn raises the risk of esophageal adenocarcinoma by 64 times. Avoid drinking alcohol, smoking, and maintaining a healthy weight can prevent the irritation of the esophagus.
Conclusion:
Barrett's esophagus is a serious complication of gastroesophageal reflux disease. Patients diagnosed with Barrett's esophagus can live a normal life. This condition is treatable and does not hold the risk of death. However, regular endoscopy is recommended to detect precancerous changes because of the increased risk of esophageal cancer.