Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Barrett’s esophagus is a condition where the inner lining of the lower end of the esophagus changes and looks like the lining of the small intestine.Â
(Stratified squamous epithelium of the esophagus changes to simple columnar epithelium with interspersed goblet cells.)
The prevalence of Barrett’s esophagus in people is 1 to 1.5 percent.
Causes of Barrett’s esophagus
The exact cause of Barrett’s esophagus is not known. It is found in 10% of patients with gastroesophageal reflux disease. It is presumed that the continuous reflux of gastric acid into the esophagus irritates the esophageal lining leading to its changes. But Barrett’s esophagus may also occur in people without gastroesophageal reflux disease.
[Read more about gastroesophageal reflux disease].
Risk factors for Barrett’s esophagus
1 Gastroesophageal reflux disease.
2 More common in people with a family history of Barrett’s esophagus.
2 Obese people.
3 It is more common in male.
4 More common in white people.
5 May occur at any age group but is more common above 50 years of age.
This is a precancerous condition because the tissues of Barrett’s esophagus may undergo different degrees of dysplastic changes and may ultimately lead to esophageal adenocarcinoma. Though the chance of developing adenocarcinoma is very small (less than 0.5 to 0.7% in patients with Barrett’s esophagus), periodic checkup is necessary.
Screening for Barrett’s esophagus may be necessary when age is above 50 years, there are multiple risk factors, daily use of medicines to control symptoms of acid reflux for a prolonged period or medicines fail to control symptoms of acid reflux.
Symptoms of Barrett’s esophagus-
Barrett’s esophagus itself may not cause any symptoms.
1 There may be symptoms of gastroesophageal reflux disease when Barrett’s esophagus is associated with it.
2 There may be blood vomiting.
3 Bloody stool or black tarry stool.
4 Unexplained weight loss.
Diagnosis of Barrett’s esophagus-
Endoscopy with biopsy of esophageal tissue is done to diagnose Barrett’s esophagus and degree of dysplastic changes in esophageal tissue.
A flexible tube mounted with light and camera (endoscope) can be passed through the mouth to visualize the esophagus. The lining of the normal esophagus looks pale and glossy but in Barrett’s esophagus it becomes thickened, red and velvety.
When Barrett’s esophagus is suspected a small tissue is collected from the affected site with the help of the endoscope for pathological study to determine the degree of dysplasia.
Degree of dysplasia in Barrett’s esophagusÂ
No dysplasia- when tissues of Barrett’s esophagus do not contain any precancerous cells.
Low grade dysplasia- When some cells show dysplastic changes, but the majority of cells remain unaffected.
High grade dysplasia- When a significant number of cells show dysplastic changes.
Treatment of Barrett’s esophagus
Treatment of Barrett’s esophagus depends upon the degree of dysplasia in esophageal cells.
No dysplasia- periodic check up with endoscopy every 2 to 3 years.
If symptoms of gastroesophageal reflux disease are present, then treatment of gastroesophageal reflux disease, Lifestyle changes, medications and surgery for gastroesophageal reflux disease done if necessary.
Low grade dysplasia-When some cells show dysplastic changes, but the majority of cells remain unaffected. More frequent endoscopic check up every six months done. In selected cases endoscopic resection, radiofrequency ablation or Cryotherapy may be done.
High grade dysplasia- High grade dysplasia means significant number of cells are affected. Here treatment options are,
Radiofrequency ablation- an endoscope is inserted into the esophagus; radio waves are delivered from the endoscope that produces heat and destroys the abnormal cells.
Cryotherapy- through an endoscope cold liquid nitrogen or carbon dioxide is applied to freeze and destroy the abnormal cells.
Photodynamic therapy- a drug called porfimer (photofrin) is injected that makes the abnormal cells light sensitive, after 24 to 72 hours with the help of an endoscope laser is applied to destroy the abnormal cells.
Endoscopic resection- abnormal tissues of the esophagus are cut and removed by an endoscope.
Frank malignancy may need surgical resection of the affected part of the esophagus (esophagectomy) and connect the remaining part with the stomach. Other options are radiotherapy and chemotherapy.
Lifelong follow up and medication is necessary to prevent recurrence.
