Barrett’S Esophagus

Barrett’s esophagus is a condition in which the lining of the esophagus is replaced by abnormal cells. The esophagus is the tube that connects the throat to the stomach. Barrett’s esophagus is a precancerous condition.

What is going on in the body?

The esophagus is connected to the stomach by the esophageal sphincter. This is a muscular ring. Normally, this muscle performs two major functions. It opens to allow food to pass into the stomach. It also closes to keep the contents of the stomach from splashing back up into the esophagus.

If this sphincter weakens or relaxes, the contents of the stomach splash back up into the esophagus. This splashing is known as gastroesophageal reflux disease, or GERD. The lining of the esophagus is not made for this kind of abuse. After being exposed to stomach acid over a long period of time, the lining of the esophagus changes. This change in the lining of the lower esophagus is called Barrett’s esophagus.

Sometimes the damaged cells lining the esophagus cause narrowing of the opening. This narrowing of the esophagus is known as an esophageal stricture. A person with this condition will have trouble swallowing food and liquids.

What are the causes and risks of the condition?

GERD is the major cause of Barrett’s esophagus. Esophagitis, or chronic inflammation of the esophagus, can also lead to Barrett’s esophagus. One-third of all people with scleroderma, a skin disorder, develop Barrett’s esophagus. For some unknown reason, Barrett’s esophagus occurs three times more often in males than in females. It is seen mainly in white men who are 40 to 50 years of age.

GERD can be caused by a weak esophageal sphincter that is present at birth or develops later in life. A hiatal hernia can also cause GERD. Hiatal hernia is a condition in which the stomach pushes up into the diaphragm muscle. When this happens, the esophageal sphincter does not work properly. As a result, the fluid can easily leak back into the esophagus.

Factors that make GERD worse include the following:

being overweight or obese

being pregnant

drinking alcohol or caffeine

drinking carbonated beverages or fruit juice

eating chocolate or peppermint

eating fatty or spicy foods

eating large meals

lying down or bending over after a meal

medicines, such as anti-inflammatory medicines

smoking or using tobacco products

What are the signs and symptoms of the condition?

Barrett’s esophagus itself does not cause symptoms. However, people with this condition almost always have symptoms from GERD.

GERD causes burning pain under the breastbone or in the upper abdomen. This pain is often called heartburn. It may increase when the person eats, bends over, or lies down. Antacids usually relieve the pain. Pain may increase at night or cause a person to wake up during the night. Other symptoms of GERD include the following:

belching a sour-tasting liquid

blood in the stool or vomit

chest pain

cough that does not go away

dental disease, such as erosion of tooth enamel

difficulty swallowing

hoarseness

loss of voice

nausea and vomiting

a need to constantly clear the throat

pneumonia

regurgitating stomach acids up into the throat

sore throat

How is the condition diagnosed?

The diagnosis of Barrett’s esophagus begins with a medical history and physical examination. The healthcare provider may then order an esophagoscopy. A thin tube with a light and camera attached to it is passed down into the esophagus. This allows a doctor to look at the inside lining of the esophagus directly through the endoscope. A small piece of the esophageal lining can be removed and examined with a microscope. This is called esophagoscopy with biopsy.

What can be done to prevent the condition?

The best way to prevent Barrett’s esophagus is to diagnose and treat GERD as early as possible.

What are the long-term effects of the condition?

A person who has Barrett’s esophagus is 30 to 40 times more likely to develop cancer of the esophagus than a person who does not have this condition. Five to 10% of the people with Barrett’s esophagus develop cancer of the esophagus.

What are the risks to others?

Barrett’s esophagus is not contagious and poses no risk to others.

What are the treatments for the condition?

Treatment of Barrett’s esophagus focuses on eliminating GERD. People with GERD can minimize symptoms by:

avoiding carbonated drinks and fruit juices

avoiding fatty or spicy foods

eating small, frequent meals

limiting caffeine intake

limiting intake of alcohol, especially red wine

managing weight to avoid obesity

not eating food within 3 hours of bedtime

not smoking or using tobacco products

sleeping with the head of the bed elevated

staying upright after eating

Some of the common medical and surgical treatments for GERD include the following:

fundoplication, a surgical procedure that strengthens the esophageal sphincter

GI stimulants that empty the stomach faster, such as metoclopramide

H₂ blockers, such as cimetidine, ranitidine, and famotidine

proton-pump inhibitors, such as omeprazole, lansoprazole, or rabeprazole

A surgical procedure known as dilation is done to correct an esophageal stricture. The surgeon passes a series of dilators down the esophagus. The dilators gently stretch the narrowed opening apart.

Unfortunately, there is nothing that can prevent the cells of Barrett’s esophagus from changing into cancer.

What are the side effects of the treatments?

Medicines used to treat GERD may cause dry mouth, bloating, and allergic reactions. Surgery can cause bleeding, infection, and allergic reaction to anesthesia.

What happens after treatment for the condition?

The abnormal cells of Barrett’s esophagus cannot be changed back into normal cells. The cells also cannot be stopped from changing into cancer. It is important to treat the GERD to prevent further damage.

How is the condition monitored?

The healthcare provider may order regular esophagoscopy exams to check for cancer. Any new or worsening symptoms should be reported to the healthcare provider.