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Barrett's Esophagus

Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus is joined to the stomach.

It is believed that the main reason that Barrett’s esophagus develops is because of chronic inflammation resulting from gastroesophageal reflux disease (GERD). Barrett’s esophagus is more common in people who have had gastroesophageal reflux disease (GERD) for a long period of time or who developed it at a young age. It is interesting that the frequency or the intensity of gastroesophageal reflux disease (GERD) symptoms, such as heartburn, does not affect the likelihood that someone will develop Barrett’s esophagus.

Most patients with Barrett’s esophagus will not develop cancer. In some patients, however, a precancerous change in the tissue, called dysplasia, will develop. That precancerous change is more likely to develop into esophageal cancer.

Who should be screened for Barrett's esophagus?
Barrett’s esophagus is twice as common in men as women. It tends to occur in middle aged Caucasian men who have had heartburn for many years. There is no agreement among experts on who should be screened. Even in patients with heartburn, Barrett’s esophagus is uncommon and esophageal cancer is rare. One recommendation is to screen patients older than 50 years of age who have had significant heartburn or who have required regular use of medications to control heartburn for several years.
 
Your doctor will perform an imaging procedure of the esophagus using endoscopy to see if there are sufficient changes in Barrett’s esophagus. The endoscope has a camera lens and a light source and projects images onto a video monitor. This allows the physician to see if there is a change in the lining of the esophagus. If your doctor suspects Barrett’s esophagus, a sample of tissue (a biopsy) will be taken to make a definitive diagnosis. Barrett’s tissue has a different appearance than the normal lining of the esophagus and is visible during endoscopy.

Taking a sample of the tissue from the esophagus through an endoscope only slightly lengthens the procedure time, causes no discomfort and rarely causes complications.
 
Medicines and/or surgery can effectively control the symptoms of gastroesophageal reflux disease (GERD). However, neither medications nor surgery for gastroesophageal reflux disease (GERD) can reverse the presence of Barrett’s esophagus or eliminate the risk of cancer. There are some treatments available that can destroy the Barrett’s tissue. These treatments may decrease the development of cancer in some patients and include heat (radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (cryotherapy) or the use of light and special chemicals (photodynamic therapy).
 
Dysplasia is a precancerous condition that doctors can only diagnose by examining tissue samples under a microscope. When dysplasia is seen in the tissue sample, it is usually described as being “high-grade,” “low-grade” or “indefinite for dysplasia.”

It is advisable to have any diagnosis of dysplasia confirmed by two different pathologists to ensure that this condition is present in the biopsy. If dysplasia is confirmed, your doctor might recommend more frequent endoscopies, or a procedure that attempts to destroy the Barrett’s tissue or esophageal surgery. Your doctor will recommend an option based on how advanced the dysplasia is and your overall medical condition.
 
The risk of esophageal cancer developing in patients with Barrett’s esophagus is quite low, approximately 0.5 percent per year (or 1 out of 200 per year). Therefore, the diagnosis of Barrett’s esophagus should not be a reason for alarm. It is, however, a reason to have periodic upper endoscopy examinations with biopsy of the Barrett’s tissue. If your initial biopsies don’t show dysplasia, endoscopy with biopsy should be repeated about every three years. If your biopsy shows dysplasia, your doctor will make further recommendations regarding the next steps.
 

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