Barrett’s esophagus

Definition

Barrett's esophagus is a disorder in which the lining of the esophagus (the tube that carries food from the throat to the stomach) is damaged because of stomach acid that leaks back into and irritates the esophagus. This leakage of acid is commonly known as "heartburn" (gastroesophageal reflux).

Causes, incidence, and risk factors

Irritation of the lining of the esophagus by gastric acid secretions (stomach acid) causes Barrett's esophagus. It occurs more frequently in men than women. Risk factors are frequent and long-standing gastroesophageal reflux. The condition carries an increased risk of cancer of the esophagus.

Symptoms

Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus results in symptoms of heartburn. Rarely, Barrett's esophagus can progress to cancer of the esophagus, which may cause difficulty swallowing or weight loss.

Signs and tests

Looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination (esophagoscopy with biopsy) may reveal Barrett's esophagus.

Treatment

Treatment includes general measures to control gastroesophageal reflux, medications, photodynamic therapy (PDT), and surgery. Treatment may be important even if the patient doesn't feel any symptoms.

General measures include:

• Weight reduction
• Avoiding lying down after meals
• Sleeping with the head of the bed elevated
• Taking medication with plenty of water
• Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure
• Avoiding alcohol and tobacco

Medications to relieve symptoms and control gastroesophageal reflux include antacids after meals and at bedtime, histamine H2 receptor blockers, proton pump inhibitors, cholinergic agents, and promotility agents.

Surgery to remove a portion of the esophagus (resection of the esophagus) may be indicated, if a biopsy shows the type of cellular changes that tend to lead to cancer (dysplasia).

Photodynamic therapy (PDT) is a newly approved option that may allow you to avoid surgery. PDT involves the use of a special laser delivery device, called an esophageal balloon, along with a drug called Photofrin. Together, the laser balloon and medication lead to ablation of the abnormal cells lining the esophagus without affecting the normal tissue.

Expectations (prognosis)

An increased risk of esophageal cancer is present. Follow-up endoscopy to look for dysplasia or cancer is often advised.

Complications

• Esophageal dysplasia
• Esophageal cancer

Calling your health care provider

Call your health care provider if heartburn persists for longer than a few days, or you have pain or difficulty swallowing.

Call your provider if symptoms worsen, do not improve with treatment, or if new symptoms develop in a person with Barrett's esophagus.

Prevention

Diagnosis and treatment of gastroesophageal reflux may prevent the onset of Barrett's esophagus.

Illustrations

Digestive system

Esophagus and stomach anatomy