Barrett's esophagus is a condition in which some of the lining of the esophagus is replaced by abnormal cells. The esophagus is the tube through which food passes from 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, then closes to keep the contents of the stomach from splashing back up into the esophagus.
If this sphincter weakens or relaxes too often, the contents of the stomach splash back up into the esophagus. This splashing is known as gastroesophageal reflux disease, or GERD. The cells lining the esophagus are sensitive to injury by stomach acid, and after being exposed over a long period of time, they become damaged.
This change in the lining of the lower esophagus is called Barrett's esophagus.
Sometimes the damaged cells lining the esophagus cause a narrowing of the opening known as an esophageal stricture. A person with this condition might have trouble swallowing food.
What are the causes and risks of the condition?
GERD is the major cause of Barrett's esophagus. Recent evidence suggests that it may also have some genetic, or inherited predisposition. 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 more frequently 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 contribute to GERD. Hiatal hernia is a condition in which the stomach pushes up into the chest through the diaphragm muscle. When this happens, the esophageal sphincter does not work optimally. 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 other tobacco products
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.
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 sample of the esophageal lining can be removed and examined with a microscope. This is called esophagoscopy with biopsy.
Long Term Effects
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
- Hblockers, such as cimetidine (i.e., Tagamet), ranitidine (i.e., Zantac), and famotidine (i.e., Fluxid, Pepcid)
- proton-pump inhibitors, such as omeprazole (i.e., Prilosec), lansoprazole (i.e., Prevacid), pantoprazole (i.e., Protonix), or rabeprazole (i.e., Aciphex)
- some newer endoscopic (with a scope) procedures
An endoscopic procedure known as dilation is done to correct an esophageal stricture. The physician passes a series of dilators down the esophagus. The dilators gently stretch the narrowed opening apart. There are some new, experimental procedures that may remove the abnormal tissue and allow new tissue, that is not precancerous, to regrow.
What are the side effects of the treatments?
Medicines used to treat GERD may cause dry mouth, bloating, and allergic reactions. Surgery and endoscopic procedures can be complicated by bleeding, infection, and allergic reaction to the anesthetic.
What happens after treatment for the condition?
The abnormal cells of Barrett's esophagus cannot be changed back into normal cells. Though a minority of people with Barrett's progress to cancer, there is at present no specific treatment to stop them from doing so. It is important to treat GERD early in its course 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.