WHAT IS BARRETT’S ESOPHAGUS?

Barrett’s esophagus is a condition in which changes occur in the lower portion of the esophagus. The esophagus is the muscular tube that connects the back of the throat to the stomach. Its inner lining is composed of squamous cells – flat cells that are similar to skin cells. Under certain conditions, the squamous cells at the base of the esophagus change their shape to be more like a column. When this happens, the condition is called Barrett’s esophagus. This process is important because Barrett’s esophagus can potentially lead to the development of cancer.

Barrett’s esophagus is usually caused by frequent and long-standing acid reflux coming up from the stomach – gastroesophageal reflux disease (GERD) – typically causing heartburn. About 10 percent of patients with GERD have Barrett’s esophagus. Barrett’s esophagus may be most common in obese white males who drink alcohol. The greatest risk factor is the persistence of GERD symptoms. People with chronic reflux problems may complain of heartburn, regurgitation of food, swallowing difficulties, excess belching, hoarseness, and symptoms similar to asthma.

While Barrett’s esophagus itself may not have any symptoms, it can rarely lead to esophageal cancer, which may lead to difficulty swallowing or weight loss. Esophageal cancer is very difficult to cure with only 15 percent of all patients surviving for five years after diagnosis. Nevertheless, the chances of developing esophageal cancer remain small, about 0.5-1.0 percent.

The only way to diagnose Barrett’s esophagus is by performing an endoscopy. This is an outpatient procedure performed under sedation in which a flexible tube is passed through your mouth, down your esophagus, and into your stomach. The doctor performing the test can look at the base of your esophagus to look for the characteristic red appearance of Barrett’s esophagus. In addition, he or she will remove a tiny piece of tissue for microscopic examination. A barium swallow will not reveal the changes of Barrett’s esophagus.

Since most people who have GERD do not have Barrett’s esophagus, many physicians feel that it is not necessary to perform endoscopy on all GERD patients. The American College of Gastroenterology recommends that anyone with uncomplicated GERD that responds to basic treatment – medications, lifestyle changes – does not need endoscopy. All others, particularly those who have had chronic GERD, should undergo endoscopy.

Treatment of Barrett’s esophagus reflects the basic treatments for GERD: weight reduction, dietary changes like avoiding fat, caffeine, and peppermint; avoiding alcohol and tobacco; and avoiding lying down after meals. Medications are available to relieve symptoms and control acid reflux. Perhaps the most important medications are proton pump inhibitors (e.g., Nexium, Prevacid, Aciphex, Protonix, Prilosec), which are very powerful suppressors of stomach acid. Antireflux surgery is also an option, but it does not seem to be more effective than medications at preventing death from cancer. Some studies suggest that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) might protect against cancer in Barrett’s esophagus.

Although the rate of progression of Barrett’s esophagus to esophageal cancer is so small, most experts are in favor of periodic repeat endoscopy to ensure that the disease has not progressed.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.