Barrett's Esophagus

Barrett's esophagus has no signs or symptoms other than the heartburn symptoms that are associated with GERD. These include a painful burning sensation in the esophagus, just below or behind the breastbone that often rises in the chest and may radiate to the neck or throat. Unlike occasional heartburn, symptoms of GERD are frequent and ongoing.

Having chronic heartburn and symptoms of GERD for more than 10 years or being young at the onset of GERD puts one at risk of developing Barrett's esophagus. So does being a current or past smoker.

Taking medications to control the signs and symptoms of GERD reduces risk. Lifestyle changes may also reduce symptoms of GERD, thereby reducing risk of Barrett's esophagus. These include:

• Maintaining a healthy weight to avoid the pressure on your abdomen caused when excess pounds push your stomach up and cause acid to back up into your esophagus
• Eating smaller, more frequent meals including small snacks in between to avoid weight gain since excess weight aggravates heartburn
• Avoiding tight-fitting clothing that aggravates reflux by putting pressure on your abdomen
• Eliminating heartburn triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine.
• Avoiding bending over for a prolonged period of time, especially soon after eating
• Avoiding lying down for at least three hours after eating
• Elevating the head of your bed 6 - 8 inches
• Quitting smoking since smoking may increase stomach acid

Patients with prolonged GERD should be monitored for Barrett's esophagus by a trained gastroenterologist. Using a procedure called upper endoscopy, the doctor inserts a lighted tube (endoscope) with a tiny camera into the esophagus to perform an examination.

If the tissue seems to be changing or appears abnormal, the doctor will perform a biopsy by taking several small samples using special tools passed through the endoscope. This tissue will be looked at under a microscope to determine the type and degree of change that has taken place. The degree of change is called dysplasia, and the type of dysplasia will dictate treatment.
If no changes are found in the cells, there is no dysplasia. Cells with small changes are said to have low-grade dysplasia. Patients with no or low-grade dysplasia are usually monitored periodically with endoscopic exams. Typically, a follow-up endoscopy is done one year later for patients with no dysplasia, then every three years thereafter if no dysplasia is detected.

Patients with low-grade dysplasia will usually have a repeat endoscopy six months or a year later along with GERD treatments that may include prescription medications and/or surgery to tighten the muscle ring that controls the flow of stomach acid. Treating GERD may control signs and symptoms, but it does not treat the underlying Barrett's esophagus.

High-grade dysplasia is known to be a pre-cursor to cancer of the esophagus. For this reason, when high-grade dysplasia is found, more invasive treatments are considered. Depending on your overall health and preference, recommended treatments may include:

• Surgery to remove the esophagus (esophagectomy). An esophagectomy is a major operation where the surgeon removes most of the esophagus and connects the portion that remains to the stomach. The risk of serious complications is reduced when the procedure is performed by an experienced surgeon, but it is still significant. Although surgery reduces the need for periodic endoscopy exams in the future, other treatments are usually preferred before surgery.
• Removing damaged cells with an endoscope (endoscopic mucosal resection). Areas of damaged cells are removed during this procedure. The doctor guides an endoscope into the esophagus through the throat. Surgical tools are passed through the endoscope allowing the doctor to cut away the damaged cells. The procedure carries a risk of complications such as bleeding, rupture and narrowing of the esophagus.
• Using heat to remove abnormal esophageal tissue (radiofrequency ablation). During this procedure, a balloon filled with electrodes is inserted in the esophagus. The balloon emits a short burst of energy that destroys the damaged esophageal tissue. Radiofrequency ablation carries a risk of narrowing of the esophagus, bleeding and chest pain. At the Capital Health Center for Digestive Health, our physicians use the HALO System for this advanced approach.
• Using cold to destroy abnormal esophagus cells (cryotherapy). Using an endoscope, cryotherapy involves applying a cold liquid or gas to the abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the cells. Cryotherapy carries a risk of chest pain, narrowing of the esophagus and tearing of the esophagus.
• Destroying damaged cells by making them sensitive to light (photodynamic therapy). This procedure involves having a medication that makes the damaged cells in the esophagus sensitive to light injected through a vein in the arm. Using an endoscope, the doctor then guides a special light down the throat and into the esophagus. The light reacts with medication in the cells and causes the damaged cells to die. The procedure causes sensitivity to sunlight and complications such as narrowing of the esophagus, chest pain and nausea may occur.

With treatments other than surgery, there is a chance that Barrett's Esophagus can recur. Doctors may recommend patients continue to take acid-reducing medications and have periodic endoscopy exams.