What is Barrett’s esophagus?
Barrett’s esophagus is a condition that affects some people with long-term gastroesophageal reflux disease (GERD), or acid reflux. Not everyone with GERD develops Barrett’s esophagus, however, long-term GERD is the primary risk factor.
In Barrett’s esophagus, the tissue lining your esophagus changes, becoming more like intestinal tissue. This happens when the digestive acid from your stomach repeatedly rises into your esophagus. This repetitive acid reflux, and resulting inflammation changes the cell structure as your esophagus tries to heal itself.
Barrett’s esophagus itself doesn’t cause any symptoms. However, it increases your risk for adenocarcinoma, a rare form of esophageal cancer. The condition doesn’t always turn into cancer, but the safest course is to see your doctor, who will recommend monitoring if Barrett’s esophagus is diagnosed.
How is Barrett’s esophagus diagnosed?
If you have GERD, your doctor may recommend screening for Barrett’s esophagus using an upper endoscopy and biopsy.
Upper endoscopy involves passing a flexible tube fitted with a tiny camera into your esophagus while you are under sedation. Tissue affected by Barrett’s esophagus will look distinctly different from ordinary, healthy esophageal tissue.
During the upper endoscopy, the physician will typically take biopsies, sampling small pieces of the abnormal tissue that will be examined under a microscope by a pathologist in a lab. The pathologist will look for signs of pre-cancerous changes (“dysplasia”), to determine your risk of developing cancer. You may have no dysplasia (no precancerous change), low-grade dysplasia, or high-grade dysplasia. Very rarely, the biopsies will disclose cancerous changes.
How can we prevent Barrett’s esophagus from turning into esophageal cancer?
Patients with Barrett’s esophagus undergo periodic upper endoscopy to monitor the status of their esophageal lining. When advanced changes such as high-grade dysplasia arise, we eradicate this tissue using endoscopic methods.
To prevent the evolution of Barrett’s esophagus along the malignancy pathway, your physician will prescribe acid suppressing medications, such as a “proton pump inhibitors” drug. Because excess acid in the lower esophagus is the cause of injury that spurs abnormal cell growth, these medicines reduce the risk of esophageal cancer in patients who have Barrett’s esophagus.
Treating Barrett’s Esophagus: It depends on the grade
The goal of treating Barrett’s esophagus is to prevent cancer from developing, or to identify it as soon as possible. Treatment depends on the grade of “dysplasia” (pre-cancerous changes) you have.
No dysplasia. If you don’t have any dysplasia, your doctor will recommend a follow-up screening after a year, with additional screenings every three years, assuming that there are no further changes. Your GERD treatment plan may also be adjusted. This can mean changes to medication or diet, or a recommendation for surgery.
Low-grade dysplasia. In this case, your doctor will recommend a follow-up screening in six months, with additional screenings every six to 12 months. Your doctor may also recommend a procedure to remove the affected cells.
High-grade dysplasia. This is considered the last stage before developing cancer, so it requires treatment to remove abnormal cells. This may include endoscopic resection, cryotherapy (freezing the cells), photodynamic therapy (using light to destroy cells) or surgery.