Barrett's disease, also called Barrett's esophagus, is a complication of gastroesophageal reflux disease, or GERD. At the junction where the esophagus meets the stomach is a circular muscle, or sphincter, that closes after food or liquids enter the stomach. With weakening of the sphincter muscle, food, fluids and acid reflux back up into the esophagus, causing damage. Barrett's affects the lining of the esophagus and increases the risk of esophageal cancer, especially adenocarcinoma. Dietary intake with low-acid foods can help reduce damage to the esophagus.
Diet and Lifestyle
Living with Barrett's disease requires changes in diet and behavior. Dietary recommendations are the same as the GERD diet, with avoidance of highly acidic foods such as tomatoes, some citrus fruits, coffee and spicy foods. Instead, lean meat, skinless chicken breast, fish, egg whites, sweet apples, bananas, melon, skim milk, goat cheese, most vegetables, whole grains, rice and oats are suggested. Decrease meal size and avoid lying down for at least three hours after eating, when the incidence of reflux is highest. To increase esophageal clearance and decrease reflux, elevate the head of the bed on 6-inch blocks or use a foam wedge.
Barrett's disease is a result of repeated injury to esophageal tissue from chronic gastric acid reflux. Normally, the mucous membrane lining of the esophagus is made up of cellular tissue called squamous epithelium. Damage from reflux alters the normal tissue, replacing it with columnar epithelium, which is more commonly found in the stomach and upper intestine. Three types of columnar cells are seen with endoscopy: gastric cardiac, gastric fundic and specialized intestinal metaplasia. Each cell type indicates its origin in the stomach and intestine.
Symptoms and Diagnosis
GERD has characteristic symptoms such as heartburn and regurgitation, but Barrett's disease doesn't cause definite symptoms. With Barrett's disease, the tissue of the esophagus becomes less sensitive due to the effects of chronic acid reflux. An endoscopic biopsy of esophageal tissue with visualization of orange gastric epithelium extending upward from the stomach in a circular manner confirms Barrett's disease.
Treatment and Complications
Treatment for Barrett's disease requires prolonged use of proton pump inhibitors, which may forestall progression of the disease, and antacids for fast relief of heartburn. With severe damage to the esophagus, procedures such as photodynamic therapy, endoscopic mucosal resection and surgery might be used. Complications include narrowing of the esophagus, as well as ulcerations. The most serious complication of Barrett's disease is esophageal adenocarcinoma. The risk of cancer is increased if specialized intestinal metaplasia is noted in biopsy results.