Barrett's esophagus is characterized by the replacement of normal tissue lining the esophagus--the tube connecting the stomach with the mouth--with abnormal tissue composed of atypical cells.The National Institutes of Health estimates approximately one percent of the population in the United States are diagnosed with Barrett's esophagus, with men having the disorder three times more often than women. Definitive diagnosis of Barrett's esophagus is made by biopsies taken during an upper gastrointestinal endoscopy. The most severe complication of Barrett's esophagus is the development of esophageal cancer, a potentially lethal type of cancer, and after being diagnosed with Barrett's, patients are advised to undergo routine surveillance for esophageal cancer with endoscopy. Gastroesophageal reflux disease, or GERD, is the only known cause of Barrett's esophagus.
Features
The lower esophageal sphincter, a muscular structure in the lower esophagus, prevents food from being squeezed out of the stomach into the esophagus by acting as a kind of gate. If the sphincter does not close properly, when the stomach contracts to push food forward into the intestines, a portion of stomach contents regurgitates back into the esophagus. According to the Mayo Clinic, this regurgitation of food and stomach acid causes damage to the esophageal lining and, as the esophagus heals, atypical cells may replace normal cells. Over time, the classic findings of Barrett's esophagus, including salmon-colored, finger-like layering of abnormal esophageal lining, become prominent.
Symptoms
Barrett's esophagus is asymptomatic. When symptoms are present, it reflects the underlying gastroesophageal reflux. MedlinePlus lists symptoms of reflux as heartburn, nausea, a feeling of food getting stuck in the throat, chronic cough, hoarseness and regurgitation of food into the mouth. With more severe GERD, there may be vomiting of blood or blood seen in the stool.
Identification
Gastroesophageal reflux disease is often presumptively diagnosed on symptoms alone. For a definitive diagnosis, an x-ray procedure that visualizes the esophagus as a contrast agent is being swallowed, called a barium swallow, can often detect the condition. Upper gastrointestinal endoscopy--the insertion of a small tube with a camera to directly image the esophageal lining--can be used to detect injury to the esophageal lining, as well as to evaluate for Barrett's esophagus. Sometimes esophageal pH monitoring, a specialized procedure to measure the amount of acid regurgitated into the esophagus, or esophageal manometry, a test done to measure the coordination of esophageal contractility as an indicator of esophageal injury, can be useful in the diagnosis of GERD, according to MedlinePlus.
Effects
The Mayo Clinic states that GERD can lead to serious complications, including Barrett's esophagus and possible esophageal cancer. GERD may also cause a chronic cough, esophageal ulcers and dental problems from acid damage to the teeth. Esophageal scarring from repeated injury by GERD can lead to narrowing of the esophagus and obstruction to food passing through to the stomach. Sometimes GERD is severe enough that stomach contents can be aspirated into the lungs, which may lead to lung inflammation, asthma and pneumonia.
Risk Factors
According MedlinePlus, there are many risks for developing GERD, including an underlying hiatal hernia, obesity, certain autoimmune diseases, as well as the use of sedatives, bronchodilators, beta-blocker and calcium channel blocker antihypertensives, tricyclic antidepressants and drugs for Parkinson's disease. Women in the later stages of pregnancy frequently have significant GERD.
Treatment
The treatment of GERD, as well as Barrett's esophagus, begins with the use of antacids; H2 blockers such as cimetidine; or proton pump inhibitors, including omeprazole and pantopazole. In cases of severe GERD refractory to drugs, surgical intervention may be necessary to control the reflux. One such surgery is a Nissen fundoplication, which is a procedure used to tighten the lower esophageal sphincter to prevent regurgitation.
Prevention
Lifestyle changes are important in controlling esophageal reflux. The Mayo Clinic lists several measures, including keeping the head of the bed elevated, avoiding large meals and tight-fitting clothes, maintaining a healthy weight and staying upright for at least 2 hours after eating. Keeping a food diary may be helpful in identifying foods that trigger episodes of reflux, and avoidance of these triggers may be helpful in diminishing episodes of gastroesophageal reflux.
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