Barrett's esophagus

Overview

Barrett's esophagus is a condition in which normal cells that line the esophagus, called squamous cells, turn into specialized columnar cells, a rare cell type. This process is called intestinal metaplasia because the specialized columnar cells are similar to the lining of the intestine. Damage to the lining of the esophagus causes the cells to change. Less than 1 percent of people with this condition develop cancer of the esophagus. However, having Barrett's esophagus may increase the risk of developing esophageal cancer.

Causes

Barrett's esophagus develops in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus). It is believed that damage to the lining of the esophagus, caused by these conditions, causes these abnormal cell changes.

People who have had long-standing heartburn are at risk for Barrett's esophagus and should discuss this with their doctor.

Symptoms

Each experience may differ, but the most common symptoms of Barrett's esophagus may include:

  • Waking in the night because of heartburn pain
  • Vomiting
  • Difficulty in swallowing
  • Blood in vomit or stool

Some people with this condition may be asymptomatic, experiencing no symptoms. Barrett's esophagus may also cause symptoms that resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Diagnosis

In addition to physical examination, the doctor will perform an endoscopy. This procedure requires a long, thin tube called an endoscope to be inserted through the mouth and gently guided into the esophagus. The endoscope contains instruments that allow the doctor to see the lining of the esophagus and to perform a biopsy, a procedure to remove a small tissue sample. The sample will be examined in a laboratory to determine whether the normal squamous cells have been replaced with columnar cells. If a person complains of trouble swallowing, an upper gastrointestinal barium study may be helpful in identifying areas of narrowing called strictures.

Treatment

Currently, there is no cure for Barrett's esophagus. Once the cells in the esophageal lining have been replaced by columnar cells, they will not revert back to normal. Thus, treatment is aimed at preventing further damage from occurring by stopping acid reflux from the stomach. Treatment may include:

  • Medication -Medications such as H2 receptor antagonists and proton pump inhibitors, which reduce the amount of acid produced in the stomach, may be prescribed by your doctor.
  • Surgery -Surgery to remove damaged tissue or a section of the esophagus may be necessary. Known as fundoplication, part of the esophagus is removed and the remaining section is attached to the stomach.
  • Dilation procedure -If strictures (narrowing of the esophagus) are present, caused when the damaged lining of the esophagus becomes thick and hardened, a procedure called dilation is used. During dilation, an instrument gently stretches the strictures and expands the opening of the esophagus.

Specific treatment for Barrett's esophagus will be determined by your doctor based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of this disease
  • Your opinion or preference

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