Definition and Overview
Barrett’s esophagus is one of the serious complications of gastroesophageal reflux disease (GERD). It is named after Dr. Norman Barrett, a British thoracic surgeon who first described it in 1950. It develops when cells on the lower portion of the esophagus go through abnormal changes and are replaced by tissue similar to the intestinal lining.
The esophagus is the muscular tube that connects the throat to the stomach. It runs behind the windpipe and in front of the spine. It is lined by mucosa or a mucous membrane that secretes slippery, jelly-like substance that acts as a protective layer.
At the lower part of the esophagus is the lower esophageal sphincter (LES), which closes as soon as food passes through it. Its main task is to ensure that food from the stomach does not flow back into the esophagus. However, if LES does not close all the way or it opens when it is not supposed to, the acid produced in the stomach can flow back up and irritate the lining of the esophagus. If this happens frequently, it could lead to intestinal metaplasia or when the normal tissue in the esophagus is replaced with tissue similar to those that line the intestine.
LES could weaken due to hiatal hernia, which causes the upper part of the stomach to slide back and forth between the chest and the abdomen through the diaphragm. This can interfere with how LES function as a barrier to reflux coming from the stomach.
Barrett’s esophagus slightly increases the risk of esophageal cancer. For this reason, patients diagnosed with the condition are advised to undergo regular examination in the hopes that should cancer develop, it will be caught early and treated before it spreads to other parts of the body.
Causes of the Condition
Barrett’s esophagus is usually diagnosed in patients with long-standing GERD. The chronic inflammation caused by acidic fluid from the stomach leads to repeated injury to the esophagus. As a protective response, the esophagus changes the cells that line it to intestinal-type cells that are more resistant to injuries.
As with most medical conditions and diseases, there are certain groups of people who have a higher risk of Barrett’s esophagus. These include:
Men and women with bulimia – Bulimia is an eating disorder that can cause severe acid reflux as purging floods the esophagus with acid from the stomach
Age – The condition is more common in older adults
Being overweight or obese
The majority of patients with Barrett’s esophagus are middle-aged white men suffering from gastroesophageal reflux for years. Most patients do not show symptoms of Barrett’s esophagus but some experience the following:
Heartburn or the burning sensation felt behind the breastbone that usually extends all the way up to the throat
Pain or burning sensation in the pit of the stomach
Regurgitation of bitter tasting fluid
Difficulty swallowing food
Unintentional weight loss
Aside from Barrett's esophagus symptoms mentioned above, patients may also experience extraesophageal symptoms of GERD if regurgitated fluid enters the lungs. These include:
New onset adult asthma
Who to See and Types of Treatments Available
Barrett’s esophagus treatment begins with assessment and diagnosis with endoscopy, in which a lighted flexible tube with a camera is passed down from the throat to check for any signs of intestinal metaplasia. If the tissue appears red and velvety (suggests the presence of Barrett’s esophagus), the doctor will obtain small amount of tissue during the same procedure for a biopsy. The sample tissue is then analysed in a laboratory to determine if the cells in the esophagus are pre-cancerous. This information is crucial as it dictates the best possible treatment for Barrett’s esophagus. If biopsy results confirm that the cells are indeed pre-cancerous, ultrasonography will be performed to evaluate for surgical resectability. Meanwhile, if surveillance endoscopy has confirmed the diagnosis of Barrett’s esophagus but no precancerous cells are found, patients are advised to undergo periodic tests as they have an increased risk of Barrett's esophagus esophageal cancer.
Aside from the presence or absence of precancerous cells in the esophagus, another factor that is being considered when determining the most appropriate treatment for the condition is the patient’s overall health status.
Barrett’s esophagus cure for patients with no precancerous cells is a combination of drug therapy and lifestyle changes, which in many cases, are proven effective in easing signs and symptoms. In slightly severe cases, surgeons may recommend a procedure that tightens the LES so the flow of stomach acid can be controlled.
Meanwhile, patients with a high risk of Barrett’s esophagus cancer are scheduled for an endoscopic resection to remove cells that are more likely to become malignant. This is followed by radiofrequency ablation for the removal of abnormal tissue in the esophagus using extreme heat. The abnormal cells can also be removed through cryotherapy with the use of an endoscope. In this procedure, cold gas or liquid is applied to abnormal cells to freeze and thaw them. In severe cases, Barrett’s esophagus surgery or esophagectomy that removes the abnormal areas of the esophagus is recommended. The esophagus is then rebuilt using parts of the small intestine or the stomach. If a part of the esophagus is removed, the remaining portion is attached to the stomach.
Diet for Barrett’s esophagus patients
Patients with Barrett’s esophagus would benefit from making lifestyle changes, which include avoiding certain types of food and drinks. These include fried or fatty foods, chocolate, peppermint, coffee, tomato sauce, carbonated beverages, vinegar, citrus fruits or juices, ketchup, and mustard, among others. Barrett's esophagus diet can help patients reduce the symptoms of GERD.
Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com. Accessed Jan. 25, 2014.
Qumseya BJ, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: A meta-analysis and systematic review. Clinical Gastroenterology and Hepatology. 2013;11:1562.