Barrett’s Esophagus

What is Barrett's Esophagus?

Barrett’s Esophagus is a condition in which the tissue of the esophagus changes and becomes similar to the lining of the small intestines.

It occurs in about 10-15 percent of patients with long-term gastroesophageal reflux disease (GERD), and it forms at the point where the esophagus meets the stomach.

Barrett’s Esophagus is not likely to lead to cancer on its own, but it can lead to a precancerous condition called dysplasia.

There are not noticeable symptoms of Barrett’s esophagus.

The most noticed signs and symptoms are usually those of GERD, which may include:

  • Frequent heartburn
  • Difficulty swallowing food
  • Chest pain

The exact cause of Barrett’s esophagus is unknown, but most people who develop it have a personal history of GERD. The general belief is that as the esophagus tries to heal itself from acid exposure, the cells can change. However, some people develop Barrett’s esophagus without ever experiencing heartburn.

If Barrett’s Esophagus is left untreated it can advance to a low or high-grade dysplasia. Dysplasia is a precancerous condition that your doctor can diagnose by examining a tissue sample under a microscope. There are three levels of dysplasia. They are described as:

  • 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.
  • high-grade dysplasia, abnormal changes are seen in many of the cells and there is an abnormal growth pattern of the cells.
  • Indefinite (or indeterminate) 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’s advised to have a dysplasia diagnosis confirmed by two different pathologists. If dysplasia is confirmed, your doctor will recommend an option based the level of the dysplasia. Possible recommendations include:

  • more frequent endoscopies
  • procedure that attempts to destory or remove Barrett’s tissue
  • esophageal surgery

The risk of esophageal cancer developing in patients Barrett’s esophagus is quite low.

Your doctor can test for Barrett’s Esophagus using an upper endoscopy and a capsule endoscopy.

During an upper endoscopy your physician will pass an endoscope, a thin and flexible tube, 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, allowing your doctor to see if there is a change in the lining of your esophagus. If your doctor suspects Barrett’s esophagus, a tissue sample will be taken to make a definitive diagnosis. 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.

During a capsule endoscopy, you will swallow a pill-sized video capsule that passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt.

Both of these techniques allow your physician to view the end of your esophagus and determine whether or not the normal lining has changed. Only an upper endoscopy can allow your doctor to take a tissue sample from the esophagus to confirm this diagnosis.

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. Because there are no noticeable symptoms, other than those of GERD, it’s usually diagnosed while examining something else.

Medicines and/or surgery can effectively control the symptoms of GERD. However, they can’t 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. Treatment options depend on the level of dysplasia found in your esophagus.

No dysplasia to Low-Grade Dysplasia treatment options include:

Periodic Endoscopy

  • You’ll probably have another endoscopy in one year and again every three years if there are no changes in cases with no dysplasia.
  • You may need another endoscopy in 6 months if low-grade dysplasia is found.

Treatment for GERD

  • Treating GERD doesn’t treat Barrett’s esophagus, but it does help to detect dysplasia.

Your doctor may recommend a follow up endoscopy every 3 years if your first two upper endoscopy examinations with biopsies (performed about one year apart) do not show dysplasia. If your biopsy shows dysplasia, then your doctor will make further recommendations regarding the next steps.

Possible High-grade treatment options include:

  • Endoscopic resection
  • Radiofrequency Ablation
  • Cryotherapy
  • Photodynamic therapy
  • Surgery to remove the damaged portion of esophagus.
  • HALO ablation
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