Barrett's Esophagus

Barrett's Esophagus is a disease, in which a change occurs within the lining of the esophagus. This esophageal lining in rare instances can change to cancer called adenocarcinoma. Barrett's Esophagus affects about 1 million people in the USA. This condition occurs because of another condition called Gastroesophageal reflux disease (GERD).

GERD is the washing up of stomach acid from the stomach against the lower end of the esophagus. This wash of acid over time can cause a change to the lining of the esophagus and Barrett's Esophagus can ensue. Having liquids occasionally reflux up is considered normal. When it happens often it is considered GERD.

The stomach makes acid and breaks down food, and when this mixture refluxes into the esophagus for a long period of time, it may cause nausea, vomiting, sour taste in the mouth, heartburn, excess salivation or collectively GERD.

Everyone has experienced these symptoms at least once, usually after consuming a large meal. When these symptoms occur often, even after small meals, the patient is diagnosed with GERD.

GERD is first treated with over the counter antacids such as ROLAIDS and TUMS. If these medications fail to relieve symptoms, H2 Blockers are utilized. Common names of these medications are ZANTAC and PEPCID. These medications can also be purchased over the counter. If these medications fail to relieve symptoms, PPI or proton pump inhibitor therapy is initiated. Most of the medications like ACIPHEX and PROTONIX are acquired after seeing a doctor and receiving a prescription, but recently OMEPRAZOLE, a PPI which has been used for many years, has been approved for over the counter usage.

Barrett's Esophagus does not cause symptoms. The risk of developing adenocarcinoma is 50-100 times higher in people who have Barrett's Esophagus than in people who do not.

At the present time, Barrett's Esophagus cannot be diagnosed by symptoms or physical exam. The only test utilized to diagnose Barrett's Esophagus is EGD and biopsy. In this test, a flexible tube containing a light and camera is put down into the esophagus and the lining of the esophagus is directly visualized. If the lining of the esophagus appears altered, biopsies are taken to rule out Barrett's Esophagus. The biopsy, retrieved with a tiny forceps or tweezer device, allows for removal of a small area in the lining of the esophagus. This tissue is then examined under the microscope to decide whether Barrett's Esophagus truly exists.

No known cure
Barrett's Esophagus has no known cure, but the goal is diagnosis and PPI therapy to prevent the progression of the disease. The theory is that by removing much of the stomach acid from the stomach, less acid will wash against the Barrett's Esophagus and the risk of progression to cancer will be reduced.

After Barrett's Esophagus is diagnosed, the patient will not only be on PPI therapy for life, but will also undergo 1 to 3 year EGD surveillance for life to look at the Barrett's Esophagus. During this surveillance, biopsies of the affected lining will be taken to make sure the Barrett's has not advanced to a more pre-cancerous or cancerous state. If high grade dysplasia (a serious early form of cancer) or advanced cancer is foundwithin the Barrett's tissue, the patient will have surgical consultation and removal of the lower portion of the esophagus may be necessary.  New techniques utilizing laser and photo therapy have been used in some instances of high grade dysplasia. The goal of surveillance EGD is to find cancer in its early stages and remove this cancer before spread or metastasis can occur. By removing the offending tissue, one can increase his or her chances of long term survival. Once cancer has spread beyond the esophagus to local or distant organs, 5 year survival is 20%. Keep in mind, the progression of Barrett's Esophagus to cancer occurs in very few patients and usually takes many years if it occurs at all (5% per year).