Barrett’s Esophagus - Causes, Symptoms, Diagnosis , and Treatment

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When GERD is left untreated it can create other problems. One possible health consequence of GERD is a condition called Barrett’s Esophagus (BE).

Barrett's esophagus is found in 5-15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, GERD)

Barrett's esophagus Causes

Barrett's esophagus is caused by gastro-oesophageal reflux disease, GORD(USA: GERD), which allows the stomach's contents to damage the cells lining the lower esophagus. Researchers are unable to predict which heartburn sufferers will develop Barrett's esophagus. While there is no relationship between the severity of heartburn and the development of Barrett's esophagus, there is a relationship between chronic heartburn and the development of Barrett's esophagus. Sometimes people with Barrett's esophagus will have no heartburn symptoms at all. In rare cases, damage to the esophagus may be caused by swallowing a corrosive substance such as lye.

The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.

Barrett's esophagus Sign and Symptoms

Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:

* frequent and longstanding heartburn
* trouble swallowing (dysphagia)
* vomiting blood
* pain under the breastbone where the esophagus meets the stomach
* unintentional weight loss because eating is painful

Diagnosis of Barrett’s Esophagus

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Diagnosis of Barrett's esophagus requires an examination called upper endoscopy or EGD (esophagogastroduodenoscopy). A barium x-ray is not accurate for detecting Barrett's esophagus. An EGD is done with the patient under sedation. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible endoscope.

Your doctor determines whether you have Barrett's esophagus using a procedure called upper endoscopy to:

* Examine your esophagus. Your doctor will pass a lighted tube (endoscope) down your throat. The tube carries a tiny camera that allows your doctor to examine your esophagus. Your doctor looks for signs that the esophageal tissue is changing. A person with Barrett's esophagus has tissue that appears different from normal esophageal tissue.

* Remove tissue samples. Your doctor may pass special tools through the endoscope to remove several small tissue samples. The samples are tested in a laboratory to determine what types of changes are taking place and how advanced the changes are.

Determining the degree of tissue changes

A doctor who specializes in examining body tissue in a laboratory (pathologist) will examine your esophageal tissue samples under a microscope. The pathologist determines the degree of changes (dysplasia) in your cells. Grades of dysplasia include:

* No dysplasia. If no changes are found in the cells, the pathologist determines there is no dysplasia.



* Low-grade dysplasia. Cells with low-grade dysplasia may show small signs of changes.



* High-grade dysplasia. Cells with high-grade dysplasia show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.



The type of dysplasia detected in your esophageal tissue determines your treatment options.

Treatments and drugs for Barrett’s Esophagus Patients
By Mayo Clinic staff

Your treatment options for Barrett's esophagus depend on the grade of changes in the cells of your esophagus, your overall health and your own preferences.

Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:

* Periodic endoscopy exams to monitor the cells in your esophagus. How often you undergo endoscopy exams will depend on your situation. Typically, if your biopsies show no dysplasia, you'll have a follow-up endoscopy one year later. If your doctor again detects no dysplasia, you may have endoscopy exams every three years. If low-grade dysplasia is detected, your doctor may recommend GERD treatments and another endoscopy in six months. If you're determined to have high-grade dysplasia, then your doctor may offer other treatment options.

Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.

* Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. This procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.

Treatment for people with high-grade dysplasia.

High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:

* Esophagectomy. Surgery to remove the esophagus. During an esophagectomy, the surgeon removes most of your esophagus and attaches your stomach to the remaining portion. Surgery carries a risk of significant complications, such as bleeding, infection and leaking from the area where the esophagus and stomach are joined. When esophagectomy is performed by an experienced surgeon, there's a reduced risk of complications. Still, because of the potential complications of this major operation, other treatments are usually preferred over surgery. One advantage to surgery is that it reduces the need for periodic endoscopy exams in the future.

* Removing damaged cells with an endoscope. Endoscopic mucosal resection is used to remove areas of damaged cells using an endoscope. Your doctor guides the endoscope down your throat and into your esophagus. Special surgical tools are passed through the tube. The tools allow your doctor to cut away the superficial layers of the esophagus and remove damaged cells. Endoscopic mucosal resection carries a risk of complications, such as bleeding, tearing of the esophagus and narrowing of the esophagus.

* Using heat to remove abnormal esophageal tissue. Radiofrequency ablation involves inserting a balloon filled with electrodes in the esophagus. The balloon emits a short burst of energy that burns the damaged esophageal tissue.

* Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain, difficulty swallowing and vomiting.

If you undergo treatment other than surgery to remove your esophagus, there's a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.

Medication and Drugs for Barrett’s Esophagus

The doctor may also prescribe medications to help. Those medications may include:

* Antacids to neutralize stomach acid.
* H2 blockers that lessen the release of stomach acid.
* Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines.
* Proton pump inhibitors that reduce the production of stomach acid.


Lifestyle and home remedies for Barrett’s Esophagus Patients
By Mayo Clinic staff

Most people diagnosed with Barrett's esophagus experience frequent heartburn and acid reflux. Medications can control these signs and symptoms, but changes to your daily life also may help. Consider trying to:

* Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you're overweight or obese, ask your doctor about healthy ways to lose weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

* Eat smaller, more frequent meals. Three meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.

* Avoid tightfitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.

* Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.

* Avoid stooping or bending. Tying your shoes is OK. Bending over for a long time to weed your garden may not be, especially soon after eating.

* Don't lie down after eating. Wait at least three hours after eating to lie down or go to bed.

* Raise the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of six to eight inches. Raising your head by using only pillows isn't a good alternative.

* Don't smoke. Smoking may increase stomach acid. If you smoke, ask your doctor about strategies for stopping.

Source: mayoclinic