Barrett’s Esophagus: Q & A
What is Barrett's esophagus and how is it treated?
Barrett's esophagus is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. Barrett's esophagus is a premalignant condition that may lead to the development of cancer of the esophagus in some patients. The risk of developing cancer is approximately 0.12 to 0.27% each year. There are a number of risk factors for the development of Barrett's esophagus, including:
Symptoms of gastroesophageal reflux disease (GERD)
Patients with Barrett's esophagus may not have any symptoms other than those associated with GERD. These include a burning sensation under the chest and acid regurgitation. Some people with GERD may also have difficulty swallowing. This symptom requires immediate medical attention. These symptoms generally decrease with medications that reduce acid in the stomach.
The only way to confirm the diagnosis of Barrett's esophagus is with a test called an upper endoscopy. This involves inserting a small lighted tube (endoscope) through the throat and into the esophagus to look for a change in the lining of the esophagus.
While the appearance of the esophagus may suggest Barrett's esophagus, the diagnosis can only be confirmed with small samples of tissue (biopsies) obtained through the endoscope. A pathologist will examine the tissue to make the diagnosis.
The treatment of Barrett's esophagus is similar to the treatment of GERD. This includes lifestyle changes, such as avoiding certain foods, not eating late in the evening, and stopping smoking, along with using medications that will decrease acid production by the stomach.
Patients with Barrett's esophagus typically need prescription medications to reduce acid, such as omeprazole (Prilosec®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), esomeprazole (Nexium®) and dexlansoprazole (Dexilant® and Kapidex®). These medications are typically taken before breakfast once a day or, on occasion, before breakfast and dinner. Over-the-counter medications known as H2 receptor antagonists (Tagamet®, Zantac®, Axid®, and Pepcid®) are generally not as effective in decreasing the acid damage to the esophagus that causes Barrett's esophagus, but may relieve symptoms for some patients. H2 receptor antagonists are also available as prescription medications.
Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia. Dysplasia can only be detected by endoscopic biopsies. Patients with Barrett's esophagus should have regular surveillance exams to detect cancer at an early and potentially curable stage.
Ablation therapy is offered for patients with dysplasia. This treatment destroys the Barrett’s tissue with radiofrequency energy or by freezing. This treatment requires multiple outpatient sessions and is effective in over 90% of patients. Over time, healthy tissue grows in place of Barrett’s. Patients with Barrett’s esophagus continue to require long-term surveillance after ablation treatments.
National Digestive Diseases Information Clearinghouse.
American Society for Gastrointestinal Endoscopy.
GERD, Barrett’s Esophagus and the Risk for Esophageal Cancer
Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology. 2011;140(3):1084-91.
Retrieved from sciencedirect.com
Jajoo K, Saltzman JR. Chapter 12. Barrett Esophagus. In: Greenberger NJ, Blumberg RS, Burakoff R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2e. New York: McGraw-Hill; 2012.
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