Barrett’s Esophagus involves a change in the normal squamous lining of the esophagus to an intestinal type as a response to acid exposure from GERD. Barrett’s Esophagus is significant because it carries an elevated risk for esophageal cancer, abut 30-125 times that of the general population. The annual risk of esophageal cancer with Barrett’s Esophagus is approximately 0.5%.
Barrett’s Esophagus is found in approximately 6-12% of patients undergoing endoscopy for GERD. The diagnosis is established with biopsies of the affected area on two separate endoscopies . Biopsies are classified in to the following categories: 1) no dysplasia (abnormal cells), 2) low grade dysplasia, and 3) high grade dysplasia.
The treatment of Barrett’s Esophagus is based on what category it falls into after biopsy. All grades of Barrett’s Esophagus are treated with medications that suppress acid secretion from the stomach. Barrett’s without dysplasia is also followed with periodic endoscopy. Barrett’s with low grade dysplasia must be followed more closely with endoscopic surveillance. More recently endoscopic therapies are available for treatment of low grade dysplasia in Barrett’s including Barrx ablation and endoscopic mucosal resection (EMR). Barrx ablation uses thermal energy to ablate or destroy the Barrett’s mucosa. EMR is another endoscopic technique where the Barrett’s mucosa is superficially resected or removed. Patients with high grade dysplasia have a high risk of progression to cancer and typically require surgery. Endoscopic therapy is also available for high grade dysplasia in patients who are not good surgical candidates.