Barrett’s esophagus is a serious condition that involves the tissue lining the esophagus. The exact cause of Barrett’s has not been discovered, but acid reflux, and especially gastroesophageal reflux disease (GERD), puts you at a greater risk of developing it. You’re not likely to develop Barrett’s if you have infrequent or mild reflux, but severe cases of GERD have been shown to significantly raise the risk.
GERD doesn’t cause Barrett’s, but it’s a risk indicator for its development.
Barrett’s is a relatively common condition — between 5 percent and 10 percent of GERD patients develop it. When you have Barrett’s, the normal tissue lining your esophagus changes into tissue resembling the lining of your intestines. The condition tends to be more prevalent in older adults.
The average age of diagnosis is 55, but it’s not always clear how long someone has had Barrett’s before diagnosis. Men are twice as likely to develop Barrett’s than women, with Caucasian men having the highest risk of developing the condition.
Why does Barrett’s matter? Because esophagus lining is like your skin, and it has no protection from acid reflux material. Intestinal lining, on the other hand, secretes mucous and bicarbonate, which offers some protection from acid. This change from one organ to another is scary — it’s like your eye becoming a third ear.
With no specific symptoms associated with Barrett’s, the condition can be difficult to discover. In order to diagnose it, you’ll have to undergo an upper gastrointestinal (GI) endoscopy and biopsy. During this procedure, a small tube is inserted through your esophagus into the stomach and duodenum. This allows your gastroenterologist to examine the esophageal tissue and look for any anomalies.
The gastroenterologist may then perform a biopsy by taking small pieces of tissue from the lower esophageal lining for microscopic analysis by the pathologist. Usually the gastroenterologist can suspect that Barrett’s changes are present simply by looking at the lower esophagus, which has a reddish appearance rather than the pearly pink of a normal healthy esophagus.
If it appears that you have Barrett’s, the gastroenterologist will likely take several biopsy samples from various levels of the esophagus.
After Barrett’s is diagnosed, it’s important for your doctor to continue to monitor the condition on a regular basis, because it can develop into cancer.
The best course of treatment will be determined by your doctor based on several factors, including your symptoms, as well as your overall health. In some cases, medication will be prescribed. Usually, it will be a PPI commonly used to combat acid reflux or GERD.
Although PPI treatment may be helpful, there’s little evidence that it will reduce your risk of Barrett’s developing into cancer. If you’ve got a long length of Barrett’s, or your Barrett’s has dysplasia (a pathology finding meaning that it is becoming bizarre looking under a microscope and is even closer to becoming cancer), or if you have a family history of esophageal cancer, your doctor will suggest one of the following:
Endoscopic ablative therapy: This procedure involves burning the Barrett’s out of the lining of your esophagus, and allowing normal esophagus lining to regrow in that area. There are two types of endoscopic ablative therapies used to treat Barrett’s:
Photodynamic therapy (PDT): During this procedure, you’re injected intravenously with a light-activated chemical called Photofrin. A day later, your doctor will use a laser attached to an endoscope to activate the Photofrin in the affected areas of your esophagus. Once activated, the Photofrin will produce a form of oxygen that destroys the surrounding cells.
In this way, your doctor can cook the esophagus cells using light-activated chemicals. However, a drawback is that your entire body is photosensitized. You’ll need to use extensive sun protection after the injection, until the doctor says you’re safe. Think vampire.
Radiofrequency ablation (RFA): This procedure uses radio waves to a similar effect. Again, an endoscope is used, this time with a balloon with a lacy wire around it that delivers heat energy to the infected area, destroying the surrounding cells. The dead tissue is scraped off, and then the RFA is applied again.
Endoscopic mucosal resection (EMR): During this procedure, your physician carefully lifts the abnormal esophageal lining and injects a special solution. After a short period, suction is applied to the abnormal area, which is sliced off and removed.
EMR is usually used when there is a specific area of your Barrett’s that is of concern, and your doctor needs to remove a chunk deeper than can be burned off with the other techniques. EMR may be used along with PDT or RFA.
In all these treatments, doctors hope to eliminate all the affected cells. After those cells are removed, your body can begin replacing them with normal esophageal cells. In some severe cases, especially if the cells have been confirmed as cancerous, your doctor asks a thoracic surgeon to remove the esophagus entirely.