Barrett's Esophagus

Overview

Barrett's esophagus is a condition that develops when the lining of the esophagus, which is the tube that connects the mouth to the stomach, becomes damaged by acid reflux. This causes the lining to thicken and become red. Over time, the lower esophageal sphincter (LES) may begin to fail, leading to acid and chemical damage of the esophagus. This condition is called gastroesophageal reflux disease (GERD), which often comes with symptoms like heartburn or regurgitation. In some cases, GERD can trigger a change in the cells lining the lower esophagus, causing Barrett's esophagus. This condition is associated with an increased risk of developing esophageal cancer, although the risk is small. Regular checkups with careful imaging and extensive biopsies of the esophagus are important to detect precancerous cells (dysplasia) and treat them to prevent esophageal cancer.

Understanding the disease

Symptoms

Symptoms of Barrett's esophagus may include frequent heartburn and regurgitation of stomach contents, difficulty swallowing food, and less commonly, chest pain. It is important to note that approximately half of the people diagnosed with Barrett's esophagus report little if any symptoms of acid reflux. If you have experienced digestive issues for more than five years, it is recommended to discuss your health with a doctor to assess your risk for Barrett's esophagus.

Risk Factors

The risk factors associated with developing Barrett's esophagus include:

1. Family history: Having a family history of Barrett's esophagus or esophageal cancer increases your risk.
2. Being male: Men are more likely to develop Barrett's esophagus.
3. Being white: White individuals have a higher risk compared to people of other races.
4. Age: The condition is more common in adults over 50.
5. Chronic heartburn and acid reflux: Having untreated or poorly controlled GERD, or requiring regular medication for GERD, increases the risk.
6. Current or past smoking: Smoking is a risk factor for Barrett's esophagus.
7. Being overweight: Excess body fat, particularly around the abdomen, can increase the risk. It's important to note that even if you have one or more of these risk factors, it does not necessarily mean you will develop Barrett's esophagus. Regular checkups and monitoring are essential for those at risk.

Development

Barrett's esophagus develops when the flat pink lining of the esophagus becomes damaged by acid reflux, causing the lining to thicken and become red. In some people, long-standing gastroesophageal reflux disease (GERD) may trigger a change in the cells lining the lower esophagus, causing Barrett's esophagus. GERD occurs when the lower esophageal sphincter (LES) fails, leading to acid and chemical damage of the esophagus. Although the risk of developing esophageal cancer is small, people with Barrett's esophagus have an increased risk of developing precancerous cells (dysplasia). The exact cause of Barrett's esophagus is not known, but it is often associated with certain risk factors, such as a family history of the condition, being male, being white, being over 50 years old, having chronic heartburn and acid reflux, smoking, and being overweight.

Assessment and Diagnosis

Triage

You should see a doctor if Barrett's esophagus is suspected, especially if you have experienced heartburn, regurgitation, and acid reflux for more than five years. Other reasons to see a doctor include: difficulty swallowing, vomiting red blood or blood that looks like coffee grounds, passing black, tarry or bloody stools, unintentionally losing weight, or experiencing chest pain (which could be a symptom of a heart attack).

Diagnosis

To diagnose Barrett's esophagus, doctors generally use endoscopy to examine the esophagus tissue. An endoscope, a lighted tube with a camera at the end, is passed down the throat to observe the condition of the esophagus tissue. In Barrett's esophagus, the tissue appears red and velvety, which is different from the pale and glossy appearance of normal tissue. Tissue samples (biopsy) are taken from the esophagus and examined by a pathologist to determine the degree of tissue change, including the presence of dysplasia. It's important for two pathologists, at least one of whom specializes in gastroenterology pathology, to agree on the diagnosis.

Management and Treatment

Complications

Complications of Barrett's esophagus include an increased risk of developing esophageal cancer. Although the risk is small, it is important to have regular checkups with careful imaging and extensive biopsies of the esophagus to check for precancerous cells (dysplasia). Additionally, people with Barrett's esophagus may experience difficulty swallowing food and rarely, chest pain.

Treatment

Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health. If your biopsies show no dysplasia, your doctor will likely recommend periodic endoscopy to monitor the cells in your esophagus. Treatment for GERD, including medication and lifestyle changes, can also help ease symptoms. If significant inflammation is present or if high-grade dysplasia is detected, more invasive treatments like endoscopic resection, radiofrequency ablation, cryotherapy, or surgery may be considered. It's essential to discuss your treatment options with your doctor and follow their recommendations for follow-up testing and care.

Preparing for medical consultation

To prepare for an appointment for Barrett's esophagus, you should:

1. Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
2. Write down your symptoms, including when they started and how they may have changed or worsened over time.
3. Make a list of all your medications, vitamins or supplements.
4. Write down your key medical information, including other diagnosed conditions. Mention if you have been hospitalized in the last few months.
5. Write down key personal information, including any recent changes or stressors in your life, as well as a detailed description of your typical daily diet, including whether you usually use caffeine and alcohol.
6. Write down questions to ask your doctor. For the appointment, consider bringing a relative or friend to help you remember the information discussed and to provide emotional support. Remember to ask your doctor about the following:

• How much of your esophagus is affected?
• How often should you be screened for changes to your esophagus?
• What is your risk of esophageal cancer?
• What are the treatment options?
• Do you need to make diet or other lifestyle changes?
• How can you best manage any other health conditions you have alongside Barrett's esophagus?