Barrett’s esophagus is the name for abnormal changes in the cells of the lower part of the esophagus (the tube that connects the mouth with the stomach). Most of the time, Barrett’s esophagus is caused by repeated exposure to acid from the stomach from gastroesophageal reflux disease though some people who get Barrett’s esophagus never have had any symptoms of acid reflux. If acid is coming into the esophagus but you have no symptoms, this is a condition called “silent reflux”. The repeated exposure to acid in the esophagus causes damage to the cells in the esophagus. When the damaged cells need to be replaced, they are replaced with lighter pink cells called columnar cells. The changes that happen with Barrett’s esophagus can be seen by a gastroenterologist when looking down into the esophagus with a small camera on the end of a long, thin tube (a procedure called upper endoscopy). The changes seen with Barrett’s esophagus are concerning because they are the first steps in esophageal cancer. People with Barrett’s esophagus are more likely to get esophageal cancer so they need to undergo more frequent screening for esophageal cancer but most people with this condition will never get esophageal cancer. When getting your upper endoscopy, your gastroenterologist will take a biopsy of the tissue. If no pre-cancerous changes (dysplasia) is present, you are far less likely to get esophageal cancer. Risk factors for Barrett’s esophagus include: having chronic acid reflux, being a man, being Caucasian (white) or Hispanic, and being older. While acid reflux is a risk factor for getting most people with acid reflux disease will not develop Barrett’s esophagus. Also, most people who have Barrett’s esophagus will not get esophageal cancer.
Heartburn, trouble swallowing, pain with swallowing, pain in the chest, vomiting blood, tarry black stool
The diagnosis of Barrett’s esophagus begins with your doctor talking with you and doing a physical exam. Your doctor will examine your abdomen closely looking for signs of any pain or abnormal masses. Your doctor will likely want to check your stool for blood which involves placing a gloved finger into the bottom to take out a tiny amount of stool to look for blood with a special lab kit. Alternatively, your doctor may ask you to collect your stool with a special kit and send it to the lab on special cards. Ultimately, Barrett’s esophagus can only be diagnosed by doing an upper endoscopy. An upper endoscopy involves taking medication to make you sleepy. Once you are sleepy, the gastroenterologist places a thin tube with a camera on the end down the esophagus to look at the inside of the esophagus. If your gastroenterologist sees anything unusual on endoscopy, he or she will likely take a small sample (biopsy) at the same time to look at under a microscope. The pathologist will look at the sample to decide what degree of change is in the tissue. No dysplasia means that the cells are not cancerous in any way. Low-grade dysplasia means small changes indicative of cancer. High-grade dysplasia means changes that are very close to being cancer.
The treatment options available for Barrett’s esophagus depends on the grade of dysplasia found on biopsy. If your biopsy shows either no dysplasia or low-grade dysplasia, your doctor will likely recommend monitoring at least every six months. Your doctor may want you to take medicine for gastroesophageal reflux disease (like a proton pump inhibitor or H2-blocker) and take another biopsy in 6 months to see if the medication has helped. Your doctor will likely want you to continue the medication for GERD. If the GERD is uncontrolled on maximum medication, your doctor may recommend a procedure called Nissen fundoplication which involve wrapping a small section of the stomach around the upper esophagus and suturing it in place in order to prevent reflux of acid into the esophagus. If you have high-grade dysplasia, your doctor may recommend more aggressive treatment in order to prevent the progression of your Barrett’s esophagus to cancer. Your gastroenterologist may recommend using a thin scope called an endoscope to look at the abnormal cells then use tiny instruments to remove the cells that look abnormal. The abnormal cells can be removed with either a tiny cutting tool, using heat to lightly burn them away, or with light (after getting a medication through your vein to make these cells sensitive to light. Your doctor may recommend removing the esophagus in a procedure called esophagectomy. During this procedure, a surgeon removes the esophagus and connects the stomach to the upper part of the esophagus. You should discuss all of your treatment options with your doctor.
