Barrett’s esophagus is a condition which the normal lining of the esophagus - the swallowing tube that carries food from the mouth to the stomach - changes and becomes like the lining of the intestine at the junction where the esophagus joins the stomach.
Those diagnosed with Barrett’s esophagus have a SMALL but increased risk of developing esophageal cancer (specifically called esophageal adenocarcinoma). This cancer is increasing frequency in the U.S. but less than 1% of people with Barrett's esophagus develop this particular cancer.
Frequent and persistent heartburn known as gastro-esophageal reflux disease (GERD) can cause Barrett’s esophagus. It is a common condition occurring in 1 out of 5 people. However, GERD does not always develop into Barrett's esophagus. In addition, not everyone with Barrett's esophagus has GERD's but Barrett's esophagus occurs in approximately 10-15% of GERD patients.
Symptoms of GERD's include burning under the breastbone, sour and bitter taste of fluid coming back into the mouth, or regurgitation.
Those with weekly GERD symptoms are 64 times more likely to get esophageal adenocarcinoma. However, 40% of patients with esophageal adenocarcinoma did NOT have symptoms of GERD. Esophageal cancer takes years to develop and it follows a sequence of changes that can be picked up and treated as long as patient’s are monitored.
An upper endoscopy or EGD is the test of choice. An outpatient procedure where a doctor passes a scope, with a light source and camera, into the mouth and examines the upper digestive tract while the patient is asleep. If there are changes to the esophageal lining suggestive of Barrett’s esophagus, then biopsies (small pieces of tissue) are collected to establish a diagnosis.
1. Treat the symptoms of GERD with medications known as proton pump inhibitors and changes in lifestyle i.e. quit smoking. This leads to a decrease in progression of Barrett’s to esophageal cancer.
2. Patients that have a known history of Barrett’s esophagus will be monitored by periodic upper endoscopy. Upper endoscopy's will be performed every 1-3 years to biopsy the segment of Barrett’s to look for cells with change also known as “dysplasia”. Dysplasia is precancerous cells which indicate a patient is at higher risk to develop cancer than the average patient with Barrett’s esophagus.
3. If dysplasia present, there are endoscopic treatments called radiofrequency ablation (or RFA) and endoscopic mucosal resection (EMR) available to destroy the Barrett’s tissue and significantly decrease the chance of developing cancer.
Once present, Barrett’s cannot be reversed. Finding Barrett’s esophagus in high-risk patients, and then monitoring these patients with EGD and biopsy can decrease the risk of getting esophageal adenocarcinoma.