Barrett’s Esophagus

A long-standing history of gastroesophageal reflux disease (GERD), also called heart burn or acid reflux is the primary reason for developing BE. About 10% of patients with GERD develop BE.

Primarily BE is seen in Caucasian male patients, obese, ages > 50 with chronic complaints of GERD. About less than 1% of the patients with BE can develop esophageal adenocarcinoma (food pipe cancer) which is potentially fatal.

There are no specific symptoms for BE. Symptoms are often related to the presence of GERD. Some patients with Barrett’s Esophagus may have silent GERD (without symptoms of acid reflux or heartburn).

However, as mentioned above, Caucasian male patients, obese, ages > 50 with chronic complaints of GERD are at a higher risk of developing BE and thereby more at a risk for BE related esophageal adenocarcinoma (BEAC). However, any patient can develop this condition if they have long-standing GERD symptoms.

Patients diagnosed with BE are at an increased risk for developing esophageal adenocarcinoma. About less than 1% of patient with BE develop adenocarcinoma. Usually, the process of developing adenocarcinoma from BE involves the stage of dysplasia (pre-malignant changes) which include low-grade dysplasia and high-grade dysplasia and then cancer.

BE →← Low-Grade Dysplasia →← High-Grade Dysplasia → Adenocarcinoma

Hence patients are continued on acid reflux medications (proton-pump inhibitors) and they undergo periodic surveillance of upper endoscopies with biopsies to detect the changes of dysplasia.

Primarily the goal of treatment should include strictly controlling the stomach acid production and thereby symptoms of GERD.

Lifestyle changes include:

• Weight loss
• Diet changes: avoiding alcohol, tobacco, and caffeinated drinks
• Sleeping with the head of the bed elevated and not lying down for 3 hours after eating.

Medications, which control acid production, include proton-pump inhibitors, antacids, H2 blockers and promotility agents. Medications help in decreasing the acid production and thereby decreasing acid exposure of the lining of the lower esophagus and thereby decreasing the incidence of BE. Medications are also primarily used even after developing low-grade dysplasia.

There are definitive therapies once high-grade dysplasia ensues. These include

1. Radiofrequency ablation (RFA), which uses radio waves delivered through an endoscope to destroy abnormal cells.
2. Endoscopic spray cryotherapy, which applies cold nitrogen or carbon dioxide gas through an endoscope to freeze and destroy the abnormal cells.
3. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is an endoscopic surgery wherein the abnormal lining of the cells are lifted off the wall and cut off via the endoscope.
4. Finally, surgery to remove the lower part of the esophagus in early cancers.