Barrett's esophagus (patient information)

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 * Assistant Editor-In-Chief: Meagan E. Doherty.

Overview
Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.

No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.

The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.

What are the symptoms of Barrett's esophagus?
Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus results in symptoms of heartburn.

What are the causes of Barrett's esophagus?
Irritation of the lining of the esophagus by stomach acid can lead to Barrett's esophagus. The irritation is caused by stomach acid that leaks and moves back up the gastrointestinal tract. This is commonly known as gastroesophageal reflux (GERD) and it can cause heartburn.

Barrett's esophagus is more common in men than women. You have a greater risk for this condition if you have frequent and long-standing GERD.

Who is at risk for Barrett's esophagus?
Risk factors include:
 * Gender: Men develop Barrett's esophagus twice as often as women
 * Race: Caucasian men are affected more frequently than men of other races

Diagnosis
Because barrett’s esophagus does not cause any symptoms, many physicians recommend that adults older than 40 who have had GERD for a number of years undergo an endoscopy and biopsies to check for the condition. Barrett’s esophagus can only be diagnosed using an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. In an upper GI endoscopy, after the patient is sedated, the doctor inserts a flexible tube called an endoscope, which has a light and a miniature camera, into the esophagus. If the tissue appears suspicious, the doctor removes several small pieces using a pincher-like device that is passed through the endoscope. A pathologist examines the tissue with a microscope to determine the diagnosis.

When to seek urgent medical care
Call your health care provider if heartburn persists for longer than a few days, or you have pain or difficulty swallowing.

Call your provider if you have been diagnosed with Barrett's esophagus and your symptoms get worse or do not improve with treatment, or if new symptoms develop.

Treatment options
Treatment may be important even if you do not feel any symptoms.

Lifestyle changes include:

 * Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure and allow stomach acid to flow backwards
 * Avoiding alcohol and tobacco
 * Avoiding lying down after meals
 * Losing weight
 * Sleeping with the head of the bed elevated
 * Taking all medications with plenty of water

Medications to relieve symptoms and control gastroesophageal reflux include:

 * Antacids after meals and at bedtime
 * Cholinergic agents
 * Histamine H2 receptor blockers
 * Promotility agents
 * Proton pump inhibitors

Endoscopic therapies
Several endoscopic therapies are available to treat severe dysplasia and cancer. During these therapies, the Barrett’s lining is destroyed or the portion of the lining that has dysplasia or cancer is cut out. The goal of the treatment is to encourage normal esophageal tissue to replace the destroyed Barrett’s lining. Endoscopic therapies are performed at specialty centers by physicians with expertise in these procedures.
 * Photodynamic therapy (PDT). PDT uses a light-sensitizing agent called Photofrin and a laser to kill precancerous and cancerous cells. Photofrin is injected into a vein and the patient returns 48 hours later. The laser light is then passed through the endoscope and activates the Photofrin to destroy Barrett’s tissue in the esophagus. Complications of PDT include chest pain, nausea, sun sensitivity for several weeks, and esophageal strictures.
 * Endoscopic mucosal resection (EMR). EMR involves lifting the Barrett’s lining and injecting a solution under it or applying suction to it and then cutting it off. The lining is then removed through the endoscope. If EMR is used to treat cancer, an endoscopic ultrasound is done first to make sure the cancer involves only the top layer of esophageal cells. The ultrasound uses sound waves that bounce off the walls of the esophagus to create a picture on a monitor. Complications of EMR can include bleeding or tearing of the esophagus. EMR is sometimes used in combination with PDT.

Surgery
Surgical removal of most of the esophagus is recommended if a person with Barrett’s esophagus is found to have severe dysplasia or cancer and can tolerate a surgical procedure. Many people with Barrett’s esophagus are older and have other medical problems that make surgery unwise; in these people, the less-invasive endoscopic treatments would be considered. Surgery soon after diagnosis of severe dysplasia or cancer may provide a person with the best chance for a cure. The type of surgery varies, but it usually involves removing most of the esophagus, pulling a portion of the stomach up into the chest, and attaching it to what remains of the esophagus.

Diseases with similar symptoms

 * Esophagitis
 * GERD

Where to find medical care for Barrett's esophagus
Directions to hospitals treating Barrett's esophagus

Prevention of Barrett's disease
Diagnosis and treatment of GERD may prevent Barrett's esophagus.

What to expect (Outlook/Prognosis)
An increased risk of esophageal cancer is present. Follow-up endoscopy to look for dysplasia or cancer is often advised.