Barrett's Esophagus

While the cause of Barrett's esophagus (BE) is unknown, we do know that GERD is a risk factor. It’s estimated that some 10 to 15 percent of people with GERD develop BE. What is the connection? GERD is a condition in which the contents of your stomach flow back up (reflux) into your esophagus. The stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus.

Since those who have GERD are at risk for developing Barrett’s esophagus, it’s important to treat the underlying condition. Doctors typically treat GERD with acid-reducing drugs.

Other risk factors of BE include smoking and obesity – particularly a high percentage of belly fat. Having a family history of Barrett’s esophagus also increases your risk.

Although Barrett's esophagus (BE) does not cause any symptoms, GERD does – most notably heartburn. If you have had GERD for a number of years and you have two or more risk factors for BE, your doctor will likely screen you for the condition through a procedure called an upper gastrointestinal (GI) endoscopy.

During the endoscopy, your doctor will obtain biopsies, or small samples, of any suspicious areas of the tissue lining the esophagus. These samples will be sent to a lab for analysis.

Since there are generally no symptoms associated with Barrett’s esophagus, doctors will treat any underlying conditions (GERD, obesity). Mild cases of GERD may be treated with lifestyle changes such as not smoking, not drinking alcohol, losing weight, and not consuming foods that irritate the esophagus.   Over-the-counter antacids such as Tums, Alka-Seltzer, Milk of Magnesia, Pepto-Bismol, etc. may also be helpful.

For moderate or more severe cases of GERD, your doctor may recommend an acid-suppressing medication known as an H2 blocker or a proton pump inhibitor (PPI). All of the following are available over the counter or in prescription strength:

H2 blockers include:

• Ranitidine (Zantac 75)
• Cimetidine (Tagamet HB)
• Famotidine (Pepcid AC)
• Nizatidine (Axid AR)

PPIs include:

• Omeprazole (Prilosec, Zegerid)
• Lansoprazole (Prevacid)
• Esomeprazole (Nexium)

These medications can prevent further damage to your esophagus and, in some cases, heal existing damage.

If you have been diagnosed with Barrett's esophagus, your doctor will also perform an endoscopy on a regular basis to check for signs of esophageal adenocarcinoma, a rare but often fatal form of esophageal cancer. Early warning signs include the presence of precancerous cells in the esophageal tissue, a condition known as dysplasia. Because cancer can occur anywhere along the esophagus, your doctor will obtain multiple biopsies to detect precancerous cells.

It’s important to receive regular screenings for esophageal cancer. If detected early, the precancerous cells can be treated to prevent cancer from developing. Treatments are not always effective in the later stages of cancer.

If you have been diagnosed with severe dysplasia or esophageal adenocarcinoma, your doctor may recommend an endoscopic or surgical treatment.

Endoscopic treatments include HALO radiofrequency ablation or endoscopic mucosal resection. HALO radiofrequency ablation kills precancerous or cancerous cells with heat generated by radio waves. The goal is to encourage normal healthy cells to grow instead.

If the doctor performs an endoscopic mucosal resection, he or she will first do an endoscopic ultrasound to ensure the cancer involves only the top layer of esophageal cells (mucosa). During the procedure, the doctor lifts the abnormal areas of esophageal tissue, injects a solution underneath or applies suction to the tissue, cuts the tissue off (resects it), and removes it through the endoscope.

For those who can tolerate surgery, this treatment may be the most effective option for a cure. The surgery, called esophagectomy, involves removing part of or the entire esophagus and rebuilding it from part of your stomach or large intestine. Depending on the size of the area affected, the surgery may be performed as an open procedure with large incisions in the abdomen, chest, and/or neck, or performed as a minimally invasive laparoscopy with a few smaller incisions.