This information explains the causes, diagnosis, and treatment of Barrett's esophagus.
What is Barrett's esophagus?
The esophagus is the tube that carries food and fluids from your mouth to your stomach. The cells that line your esophagus are called squamous cells. In Barrett's esophagus, these cells are replaced by a type of cell not usually found in the esophagus. These new cells look more like the cells that line the intestines. This process is called intestinal metaplasia.
What causes Barrett's esophagus and who is at risk?
The exact cause of Barrett's esophagus is not known. Most people with Barrett's esophagus have long-standing gastroesophageal reflux disease (GERD). GERD is the backflow of stomach contents into the esophagus. It is commonly called reflux. It can cause a burning feeling in the throat or chest known as heartburn. Over time, the stomach acid and bile cause damage to the lining of the esophagus. A small number of people with a history of GERD can develop Barrett's esophagus if this damage is severe. In addition, people who develop Barrett's esophagus are usually:
- Obese or overweight
Having Barrett's esophagus can increase the risk of developing esophageal cancer. Because of this, we urge you to have regular medical check-ups and follow the treatment that your doctor advises.
How is the diagnosis of Barrett's esophagus made?
Barrett's esophagus is diagnosed with an endoscopy. An endoscopy is an exam that lets your doctor look at the lining of your esophagus. This is done by passing a lighted tube with a tiny camera on the end of it down your throat (see Figure 2). You will have anesthesia so you will not feel any discomfort. The doctor looks for signs that the esophageal tissue is changing. He or she may pass special instruments through the endoscope to remove several small tissue samples. A pathologist tests the samples to see what types of changes are taking place.
What is the treatment for Barrett's esophagus?
Most people with Barrett's esophagus are given medicine to treat GERD. These medicines help reduce the acid in your stomach. They also may help prevent irritation to the esophagus. If medicine does not improve your symptoms, anti-reflux surgery may be recommended. These treatments do not cure Barrett's esophagus but they may slow its progress.
Treatment for dysplasia
The treatment for Barrett's esophagus will be different if pre-cancerous tissue is found. This tissue is called dysplasia. Levels of dysplasia range from low-grade to high-grade. The level of dysplasia influences the risk of progressing to cancer and determines the type of treatment needed. The two main types of treatment for dysplasia are endoscopic treatments and surgery.
If you have low-grade dysplasia:
The risk of progressing to cancer with limited low-grade dysplasia is felt to be low. Doctors generally recommend monitoring with more frequent exams. However, if there are multiple areas of low-grade dysplasia, the risk of progressing to cancer is higher.
Endoscopic treatments aim to destroy or remove the abnormal tissue without surgery. The types of endoscopic treatments include:
- Endoscopic mucosal resection (EMR). A salt solution may be injected under the abnormal tissue to raise it during the endoscopy exam. The tissue is then shaved off and examined.
- Radiofrequency ablation (RFA). A special device is passed down your throat. It gives short bursts of intense radio waves to destroy the abnormal tissue with heat.
- Cryoablation. Extremely cold liquid and gas are delivered through the endoscope to freeze and destroy abnormal cells.
- Photodynamic therapy (PDT). Light-sensitive medicine and red laser light are used to kill abnormal cells.
If you have high-grade dysplasia:
The risk of progressing to cancer with high-grade dysplasia is felt to be very high. The treatments listed above can be used to treat patients with high-grade dysplasia. Otherwise, your doctor may recommend surgery to remove the esophagus. This is called an esophagectomy. Your doctor will tell you more about it if he or she recommends it for you.
What can I do if I am diagnosed with Barrett's esophagus?
Your doctor will recommend treatment and follow-up exams. In addition, try to follow some lifestyle changes such as:
- Sitting up after meals
- Avoiding food 2 to 3 hours before bedtime
- Avoiding foods that cause more acid such as caffeinated foods (coffee, teas, colas, and chocolate) and alcohol
- Sleeping with the head of the bed elevated so your head is above your stomach
- Avoiding large, fatty meals
Where can I get more information about Barrett's esophagus?
Your nurse or doctor can give you the GERD fact card with more information. You can also find a lot of information on the Internet. Here is a list of trustworthy websites that we recommend:
Please contact your doctor or nurse if you have any questions.