People who experience persistent heartburn are at risk of developing Barrett’s oesophagus. The chronic reflux of gastric juices causes changes in the cell lining of the lower oesophagus, which can sometimes turn cancerous. Treatment includes medication and surgery.
What is Barrett’s esophagus?
Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach—is replaced by tissue that is similar to the intestinal lining. This process is called intestinal metaplasia. People with Barrett’s esophagus are at increased risk for a rare type of cancer called esophageal adenocarcinoma.
How common is Barrett’s esophagus and who is affected?
The true prevalence of Barrett’s esophagus is unknown, but it is estimated to affect 1.6 to 6.8 percent of people.1 The average age at diagnosis is 55, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.
What causes Barrett’s esophagus?
The exact cause of Barrett’s esophagus is unknown, but gastroesophageal reflux disease (GERD) is a risk factor for the condition. GERD is a more serious, chronic—or long lasting—form of gastroesophageal reflux, a condition in which stomach contents flow back up into the esophagus. Refluxed stomach acid that touches the lining of the esophagus can cause heartburn and damage the cells in the esophagus. Heartburn, also called acid indigestion, is an uncomfortable, burning feeling in the midchest, behind the breastbone, or in the upper part of the abdomen—the area between the chest and hips.
What factors lower a person’s risk of Barrett’s esophagus?
Helicobacter pylori (H. pylori) infection may decrease the risk of developing Barrett’s esophagus. H. pylori is a spiral-shaped bacterium found in the stomach that damages the stomach and the tissue in the duodenum—the first part of the small intestine. The mechanism by which H. pylori provides protection from Barrett’s esophagus is unclear. While the bacteria damage the stomach and the tissue in the duodenum, some researchers believe the bacteria can actually make the stomach contents less damaging to the esophagus when GERD is present. Other factors that may reduce the risk of developing Barrett’s esophagus include frequent use of aspirin or other nonsteroidal anti-inflammatory drugs and high intake of fruits, vegetables, and vitamins.+
Diagnosis of Barrett’s oesophagus
Diagnosing Barrett’s oesophagus involves a number of tests, including:
- Endoscopy – a thin tube is swallowed so that the doctor can see inside the oesophagus.
- Endoscopic biopsy – a small tag of tissue is removed during an endoscopy and examined for the presence of cellular changes. Barrett’s oesophagus cannot be diagnosed without this biopsy.
- Twenty-four hour ambulatory pH monitoring – a thin wire is threaded through the nose into the oesophagus and connected to a small recorder. This device is worn on the body, usually for 24 hours. This records the level of acid bathing the lower gullet and is an effective way of proving that therapy is adequate.
How is Barrett’s esophagus treated?
A health care provider will discuss treatment options for Barrett’s esophagus based on the person’s overall health, whether dysplasia is present, and, if so, the severity of the dysplasia. Treatment options include medication, endoscopic ablative therapies, endoscopic mucosal resection, and surgery.
People with Barrett’s esophagus who have GERD are treated with acid-suppressing medications, called proton pump inhibitors. These medications are used to prevent further damage to the esophagus and, in some cases, heal existing damage. Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength. Anti-reflux surgery may be considered for people with GERD symptoms who do not respond to medications. However, medications or surgery for GERD and Barrett’s esophagus have not been shown to lower a person’s risk of dysplasia or esophageal adenocarcinoma.
Endoscopic ablative therapies
Endoscopic ablative therapies use different techniques to destroy the dysplastic cells in the esophagus. The body should then begin making normal esophageal cells. These procedures are performed by a radiologist—a doctor who specializes in medical imaging—at certain hospitals and outpatient centers. Local anesthesia and a sedative are used. The procedures most often used are photodynamic therapy and radiofrequency ablation.
- Photodynamic therapy. Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in the esophagus. When porfimer is exposed to laser light, it produces a form of oxygen that kills nearby cells. Porfimer is injected into a vein, and the person returns 24 to 72 hours later to complete the procedure. The laser light passes through the endoscope and activates the porfimer to destroy Barrett’s tissue in the esophagus. Complications of photodynamic therapy include sensitivity of the skin and eyes to light for about 6 weeks after the procedure; burns, swelling, pain, and scarring in nearby healthy tissue; and coughing, trouble swallowing, stomach pain, painful breathing, and shortness of breath.
- Radiofrequency ablation. Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells. An electrode mounted on a balloon or endoscope delivers heat energy to the Barrett’s tissue. Complications include chest pain, cuts in the mucosal layer of the esophagus, and strictures—narrowing of the esophagus. Clinical trials have shown a lower incidence of side effects for radiofrequency ablation compared with photodynamic therapy.
Endoscopic mucosal resection
Endoscopic mucosal resection involves lifting the Barrett’s lining and injecting a solution underneath or applying suction to the lining and then cutting the lining off. The lining is then removed with an endoscope. The procedure is performed by a radiologist at certain hospitals and outpatient centers. Local anesthesia and a sedative are used. If endoscopic mucosal resection is used to treat cancer, an endoscopic ultrasound is done first to make sure the cancer involves only the top layer of esophageal cells. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.
Complications can include bleeding or tearing of the esophagus. Endoscopic mucosal resection is sometimes used in combination with photodynamic therapy.
Surgery for Barrett’s esophagus is an alternative; however, endoscopic therapies are preferred by many health care providers due to fewer complications following the procedure.
Esophagectomy is surgical removal of the affected sections of the esophagus. After removal, the esophagus is rebuilt from part of the stomach or large intestine. The procedure is performed by a surgeon at a hospital, and general anesthesia is used. The patient stays in the hospital for 7 to 14 days after the surgery to recover. Surgery may not be an option for people with Barrett’s esophagus who have other medical problems. For these people, the less-invasive endoscopic treatments or continued intensive surveillance would be considered.
Eating, Diet, and Nutrition
People can make dietary changes to lower their risk of Barrett’s esophagus. A high intake of fruits, vegetables, and vitamins may help prevent the disease. In addition, for people who are overweight, losing weight may reduce their risk. People should talk with their health care provider about dietary changes that can help prevent Barrett’s esophagus.