Barrett's esophagus is a premalignant condition that increases the risk of esophageal cancer. According to the National Digestive Diseases Information Clearinghouse, Barrett's esophagus affects approximately 1 percent of adults in the United States, with an average age at diagnosis of 50 years.
Definition
The esophagus is a tube that transports food from the mouth to the stomach. The esophagus is lined by tissue containing specialized cells specifically made to withstand the transit of food. Barrett's esophagus occurs when the cells lining the esophagus change in structure and show abnormal features, which can be mild or severe. Persistent exposure to stomach acid is thought to be responsible for this change. According to an article in the December 2009 issue of the New England Journal of Medicine, approximately 0.5 percent of patients with Barrett's esophagus go on to develop esophageal cancer each year.
Risk Factors
Barrett's esophagus is more common in men, Caucasians, Hispanics, older individuals and those with chronic acid reflux; also known as GERD. GERD, which stands for gastroesophageal reflux, is a disease caused by the reflux of stomach acid into the esophagus, leading to symptoms of heartburn. While many people experience heartburn, more than two episodes per week is considered GERD. Barrett's esophagus is more common in people with GERD. No symptoms are specific to Barrett's esophagus; the symptoms experienced by the patient tend to be those of GERD.
Diagnosis
Barrett's esophagus is diagnosed by endoscopy, a procedure in which a tube with a tiny camera is inserted into the esophagus. The endoscopy not only allows the physician to visualise the esophagus, but also to take biopsies---tiny cores of tissue that are sent to a pathologist for examination under the microscope. Microscopic examination is the only way Barrett's esophagus can be definitively diagnosed.
Treatment
Treatment is dependent on the pathologist's report. For patients with no changes or mild changes, regular endoscopies are required in order to monitor the cells in the esophagus. If chronic acid reflux is still an issue, treatment regimens can be reviewed and if necessary, improved. Patients with severe changes in the esophagus are at higher risk of esophageal cancer, therefore treatment involves more invasive procedures that either remove part of the esophagus or part of the lining of the esophagus.
Monitoring
For patients in whom mild changes are found, repeat endoscopy is generally done twice in the initial year and then annually thereafter. In patients in whom no changes are found, after two consecutive normal endoscopies one year apart, monitoring may be done every three years.
References
- National Digestive Diseases Information Clearinghouse (NDDIC): Barrett's Esophagus
- The New England Journal of Medicine; Barrett's Esophagus; Prateek Sharma; December 2009
- MayoClinic.com: Barrett's Esophagus
