Barrett's Esophagus

Barrett's esophagus is a medical condition affecting the lining of the esophagus. The esophagus is a muscular tube that begins at the base of the mouth and extends to the top of the stomach. The change in the esophagus that leads to Barrett's esophagus is called metaplasia. Metaplasia describes precancerous tissue that would turn into cancer in many cases if not treated.

Most people with Barrett's esophagus have gastroesophageal reflux disease although there are no specific symptoms of Barrett's esophagus itself. One percent of adults in the US have Barrett's esophagus with an average age of fifty years at diagnosis. It occurs twice as often in men as in women. Caucasians are more affected than other races. It is rare to see Barrett's esophagus in children.

Normally, the esophagus carries food and liquid from the oral cavity to the stomach. The stomach has a sphincter at the top that keeps acid and food from going up into the esophageal cavity. This leads to heart burn and eventually erosion of the esophageal lining. When this happens over and over again, it can lead to metaplastic or precancerous changes to the esophagus. Gastroesophageal reflux disease or GERD is the most common precursor to Barrett's esophagus. It is painful and feels like a burning or aching pain in the mid chest. It can also lead to bad breath, acid in the back of the throat and a sore throat, if the acid rises to that level. You can sometimes feel or taste acid or food at the back of the mouth.

It is considered to be GERD if you have heartburn or related symptoms more than twice per week. About ten to twenty percent of US citizens have GERD symptoms every day, making it the most common medical condition out there. It can affect people of all ages, including infants. Only one percent or less of these people go on to having Barrett's esophagus.

The treatments of reflux disease are acid reducing agents such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol and H2 blockers like Tagamet, Pepcid AC, Zantac, and Axid. Proton pump inhibitors stop the production of acid in the stomach and include Nexium, Prevacid and, Aciphex, and Prilosec. Those with GERD should see a doctor about getting on medications for acid reflux disease. Some may need evaluation for Barrett's esophagus. Besides esophageal reflux and Barrett's esophagus, you can get esophageal stricture-narrowing of the esophagus that prevents food from passing through to the stomach.

Interestingly, you can get Barrett's esophagus without having GERD but it is 3 to 5 times more likely that you will get Barrett's esophagus if you also have reflex disease. Because GERD leads to Barrett's in many cases, it is a good idea to treat your GERD with anti-acid drugs or acid reducers. If you improve GERD symptoms, you have a good chance of reducing your risk of developing Barrett's esophagus.

Barrett's esophagus can be diagnosed by an endoscopy, which is a camera study involving a flexible tube that extends from the mouth down the esophagus. Biopsies can be obtained in order to identify whether or not metaplasia, as seen in Barrett's esophagus, is found. This can be done anytime but is frequently done past the age of forty, when GERD is most prevalent and Barrett's esophagus has had time to develop.

So who gets esophageal cancer with Barrett's esophagus? It is actually only a one percent risk of having esophageal adenocarcinoma following Barrett's esophagus. The Barrett's esophagus usually needs to be there for several years before the cancer shows up. You diagnose esophageal cancer with an endoscope too, and there is often pain associated with esophageal adenocarcinoma.

Doctors will do periodic endoscopic evaluations for those with known Barrett's esophagus. This type of surveillance will tell when Barrett's esophagus is turning into cancer of the esophagus. The tissue becomes more cancerous-looking and is called dysplasia. This indicates a cancerous transformation that needs to be treated. The treatment of Barrett's esophagus can be done via the endoscope or through surgical measures.

Endoscopic procedures include photodynamic therapy which uses light to kill the precancerous cells. A light sensitizing agent is injected into the tissue before the laser light is used. The light-sensitizing agent is called Photofrin. Another procedure involves lifting up the Barrett's esophagus lining by injecting a solution under it and suctioning off the lining of the esophagus that is damaged.