What is Barrett's Esophagus?
Barrett's esophagus is a condition in which
the lining of the esophagus changes, becoming
more like the lining of the small intestine
rather than the esophagus. This occurs in the
area where the esophagus is joined to the
stomach.
It is
believed that the main reason that Barrett's
esophagus develops is because of chronic
inflammation resulting from Barrett's
Gastroesophageal Reflux Disease (GERD).
Barrett's esophagus is more common in people who
have had GERD for a long period of time or who
developed it at a young age. It is interesting
that the frequency or the intensity of GERD
symptoms, such as heartburn, does not affect the
likelihood that someone will develop Barrett's
esophagus.
Most patients with Barrett's
esophagus will not develop cancer. In some
patients, however, a precancerous change in the
tissue, called dysplasia, will develop. That
precancerous change is more likely to develop
into esophageal cancer.
At the current
time, a diagnosis of Barrett's esophagus can
only be made using endoscopy and detecting a
change in the lining of the esophagus that can
be confirmed by a biopsy of the tissue. The
definitive diagnosis of Barrett's esophagus
requires biopsy confirmation of the change in
the lining of the esophagus.
Am I
at risk for esophageal cancer?
There
are two main types of esophageal cancer:
squamous cell cancer and adenocarcinoma of the
esophagus. Squamous cell cancers occur most
commonly in individuals who smoke cigarettes,
use tobacco products and drink alcohol. In
addition, African Americans are also at
increased risk of developing this type of
cancer. This cancer is also very common in many
areas in Asia. The frequency of squamous cell
cancer of the esophagus in the United States has
remained the same. Another cancer,
adenocarcinoma of the esophagus, occurs most
commonly in people with GERD. It is also very
common in Caucasian males with increased body
weight. Adenocarcinoma of the esophagus is
increasing in frequency in the United States.
The most common symptom of GERD is
heartburn, a condition that 20 percent of
American adults experience at least twice a
week. Although these individuals are at
increased risk of developing esophageal cancer,
the vast majority of them will never develop it.
In a few patients with GERD (about 10 to 15
percent of patients), a change in the lining of
the esophagus develops near the area where the
esophagus and stomach join. When this happens,
the condition is called Barrett's esophagus.
Doctors believe that most cases of
adenocarcinoma of the esophagus begin in
Barrett's esophagus.
How does my
doctor test for Barrett's Esophagus?
Your doctor will first perform an imaging
procedure of the esophagus using endoscopy to
see if there are sufficient changes for
Barrett's esophagus. In an upper endoscopy, the
physician passes a thin, flexible tube called an
endoscope through your mouth and into the
esophagus, stomach and duodenum. The endoscope
has a camera lens and a light source and
projects images onto a video monitor. This
allows the physician to see if there is a change
in the lining of the esophagus. If your doctor
suspects Barrett's esophagus, a sample of tissue
(a biopsy) will be taken to make a definitive
diagnosis.
Capsule Endoscopy is another test that has been
used to examine the esophagus. In capsule
endoscopy, the patient swallows a pill-sized
video capsule that passes naturally through your
digestive tract while transmitting video images
to a data recorder worn on your belt. With
capsule endoscopy, the physician is not able to
take a sample of the tissue (a biopsy).
Both of these techniques allow the physician to
view the end of the esophagus and determine
whether or not the normal lining has changed.
Only an upper endoscopy procedure can allow the
doctor to take a sample of the tissue from the
esophagus to confirm this diagnosis, as well as
to look for changes of potential dysplasia that
cannot be determined on endoscopic appearance
alone. Barrett's tissue has a different
appearance than the normal lining of the
esophagus and is visible during endoscopy.
Taking a sample of the tissue from the
esophagus through an endoscope only slightly
lengthens the procedure time, causes no
discomfort and rarely causes complications. Your
doctor can usually tell you the results of your
endoscopy after the procedure, but you will have
to wait a few days for the biopsy results.
Who should be screened for Barrett's
Esophagus?
Barrett's esophagus is
twice as common in men as women. It tends to
occur in
middle-aged Caucasian men who have had heartburn
for many years. There is no agreement among
experts on who should be screened. Even in
patients with heartburn, Barrett's esophagus is
uncommon and esophageal cancer is rare. One
recommendation is to screen patients older than
50 years of age who have had significant
heartburn or who have required regular use of
medications to control heartburn for several
years. If that first screening is negative for
Barrett's tissue, there is no need to repeat it.
There is a great deal of ongoing research in
this area and so recommendations may change. You
should check with your doctor on the latest
recommendations.
How is Barrett's
Esophagus treated?
Medicines and/or
surgery can effectively control the symptoms of
GERD. However, neither medications nor surgery
for GERD can reverse the presence of Barrett's
esophagus or eliminate the risk of cancer. There
are some treatments available that can destroy
the Barrett's tissue. These treatments may
decrease the development of cancer in some
patients and include heat (radiofrequency
ablation, thermal ablation with argon plasma
coagulation and multipolar coagulation), cold
energy (cryotherapy) or the
use of light and special chemicals (photodynamic
therapy).
It is necessary to discuss the
availability and the effectiveness of these
treatments with your gastroenterologist to be
certain that you are a candidate. There are
potential risks from these treatments and they
may not benefit the majority of patients with
Barrett's esophagus. There is much research
being conducted in this area; you should talk
with your doctor about recommendations and
guidelines.
What is dysplasia?
Dysplasia is a precancerous condition that
doctors can only diagnose by examining tissue
samples under a microscope. When dysplasia is
seen in the tissue sample, it is usually
described as being "high-grade," "low-grade" or
"indefinite for dysplasia."
In high-grade
dysplasia, abnormal changes are seen in many of
the cells and there is an abnormal growth
pattern of the cells. Low-grade dysplasia means
that there are some abnormal changes seen in the
tissue sample but the changes do not involve
most of the cells, and the growth pattern of the
cells is still normal. "Indefinite for
dysplasia" simply means that the pathologist is
not certain whether changes seen in the tissue
are caused by dysplasia. Other conditions, such
as inflammation or swelling of the esophageal
lining, can make cells appear dysplastic when
they may not be.
It is advisable to have
any diagnosis of dysplasia confirmed by two
different pathologists to ensure that this
condition is present in the biopsy. If dysplasia
is confirmed, your doctor might recommend more
frequent endoscopies, or a procedure that
attempts to destroy the Barrett's tissue or
esophageal surgery. Your doctor will recommend
an option based on how advanced the dysplasia is
and your overall medical condition.
If I
have Barrett's Esophagus, how often should I
have an endoscopy to check for dysplasia??
The risk of esophageal cancer developing in
patients with Barrett's esophagus is quite low,
approximately 0.5 percent per year (or 1 out of
200 per year). Therefore, the diagnosis of
Barrett's esophagus should not be a reason for
alarm. It is, however, a reason to have periodic
upper endoscopy examinations with biopsy of the
Barrett's tissue. If your initial biopsies don't
show dysplasia, endoscopy with biopsy should be
repeated about every three years. If your biopsy
shows dysplasia, your doctor will make further
recommendations regarding the next steps.
F.Y.I.
Barrett's
Esophagus may be related to GERD (Gastroesophageal Reflux
Disease), which occurs when contents in the
stomach flow back into the esophagus due to the
valve between the stomach and the esophagus not
closing properly.
IMPORTANT REMINDER:
The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.