Barrett’s Esophagus

The esophagus is the long tube that is responsible for moving food from the throat to the stomach. Barrett’s esophagus is a condition that affects the esophagus and is a common problem for people who have long-term gastroesophageal reflux disease (GERD). Barrett’s esophagus occurs when there is chronic regurgitation of acid from the stomach into the esophagus. This condition changes the structure of the lining of the esophagus, transforming it so that it more closely resembles the lining of the intestine. Up to 40 percent of patients with Barrett’s esophagus may never have symptoms of acid reflux despite having Barrett’s esophagus.

When this condition develops, it increases a person’s risk of esophageal cancer (esophageal adenocarcinoma). This is because Barrett’s esophagus can create dysplasia, which is a precancerous change that affects tissue. Most cases of Barrett’s esophagus do not lead to cancer, but it is still important to receive regular screenings so that your provider can catch dysplasia early when there are options to eradicate or remove it.

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Causes of Barrett’s Esophagus

The exact cause of Barrett’s esophagus is not yet known. However, the condition is most often seen in people with GERD. In GERD, acidic fluid washes back into the esophagus from the stomach and damages the normal esophagus tissue. As the esophagus heals, the damaged cells can change into those cells seen in Barrett’s esophagus.

If you have GERD symptoms for longer than 10 years, you have an increased risk of developing Barrett’s esophagus. However, other conditions, traits or habits may also play a role in raising your risk for this disease. These conditions are known as risk factors.

Non-Modifiable Risk Factors: These factors are irreversible and cannot be changed. The more of these risk factors you have, the greater your chance of developing this condition:

• Family history of Barrett’s esophagus or esophageal cancer
• Male gender
• Caucasian race
• Age greater than 50 years old

Modifiable Risk Factors: These factors can be modified, treated or controlled through medications or lifestyle changes.

• Long history of cigarette smoking and/or drug abuse
• Obesity or having a body mass index “BMI” of 30 or greater
• Excessive amounts of alcohol consumption over the years
• Eating large portions at meals
• Consumption of spicy foods
• Going to bed or lying down less than four hours after eating

Other condition that contributes to Barrett’s esophagus:

• H. Pylori gastritis: A type of bacteria that infects and inflames the stomach’s lining

Symptoms of Barrett’s Esophagus

There are no specific symptoms associated with Barrett’s esophagus. However, 60 percent of people with this condition also have symptomatic GERD, they will experience symptoms, which include:

• Chest pain
• Difficulty swallowing
• Regurgitation of food or sour liquid
• Vomiting blood, or vomit that resembles coffee grounds

A person may also have silent reflux (have GERD but not be symptomatic) and develop Barrett’s esophagus.

Diagnosis of Barrett’s Esophagus

If Barrett’s esophagus is suspected, a doctor will most likely perform a physical exam and ask about the patient’s symptoms, risk factors and other relevant medical history. After that, the doctor may ask for other diagnostic tests and procedures.

Balloon Cell Collection

An advanced diagnostic method to collect cells for analysis is to use a small, tethered capsule about the size of a vitamin, which the patient swallows. A balloon is inflated at the end of the capsule, and the balloon’s textured surface swabs the surface of the esophagus and captures cells for analysis as it is pulled upward. The balloon is deflated, and the capsule is removed through the mouth. The cells are then analyzed to detect signs of Barrett's esophagus. This non-endoscopic procedure can be done in the doctor’s office and only takes a few minutes.

Endoscopy

In an endoscopy, a long tube with a light and camera on the end — called an endoscope — is passed through the mouth, down the throat, and into the esophagus to enable a doctor to view the inside of the upper gastrointestinal tract.

The doctor may biopsy the esophagus tissue to confirm a diagnosis of Barrett’s esophagus. An advanced biopsy technology called wide-area transepithelial sampling with 3D analysis (WATS 3D) can be used to help increase detection of precancerous areas of the esophagus. This technology uses artificial intelligence (AI) to reliably detect precancerous cells more readily.

A pathologist (doctor who examines the esophagus tissues cells) determines if precancerous cells or dysplasia is present in the Barrett’s tissue. . Dysplasia is graded as either low-grade or high-grade.

If there is no dysplasia, the goal is to treat GERD with medication and lifestyle changes. Periodic endoscopy to monitor for any further changes in the esophagus cells is also recommended. An endoscopy is usually repeated every 3 to 5 years if there is no dysplasia.

If there is low-grade dysplasia, two potential options are available. One option is to treat GERD with medications and lifestyle changes and repeat an endoscopy in 6-12 months. The other option is to endoscopically treat the area of Barrett’s esophagus given the increased risk of developing esophageal cancer. Endoscopic therapy is a minimally invasive method.

If there is high-grade dysplasia, there is a higher chance of developing esophageal cancer. The standard of care is to undergo endoscopic eradication treatment.

Treatment of Barrett’s Esophagus

The goal of treatment is to reduce or eliminate the risk of developing esophageal cancer.

Lifestyle Changes

• Eat a heart-healthy diet.
• Avoid smoking.
• Avoid alcohol consumption.
• If you are overweight, talk to your doctor about weight loss options.
• Keep your body upright for three hours after eating.
• Drink plenty of water.
• Keep a regulated medication schedule.
• Sleep with your head elevated.
• Exercise under the directions of your doctor.
• Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications

• A proton pump inhibitor can help with the treatment of heartburn and acid-related disorders.

Medical and Surgical Procedures

• Endoscopic resection. Small tools passed through the endoscope are used to remove the abnormal cells.
• Cryotherapy. Also known as cryosurgery or cryoablation, cryotherapy is an FDA-approved technique where a balloon is inflated in the esophagus and nitrous oxide is released within the balloon. The balloon contacts the esophagus lining, freezing it to temperatures that ablate or destroy the superficial lining of the esophagus, removing the Barrett’s cells. Normal cells grow in its place when the esophagus heals. Usually, one session every three months is required until the Barrett’s cells are gone. Studies have shown that cryotherapy can be especially useful when radiofrequency ablation (RFA) is not working. It is also less painful than RFA.
  • Radiofrequency ablation (RFA). This is an FDA-approved technique where heat energy is used to destroy the abnormal cells. When the area heals, the abnormal cells are replaced by normal esophageal cells. Often, a few sessions of radiofrequency ablation about 3 months apart are needed to fully remove the damaged cells.
  • Hybrid argon plasma coagulation. This is a newer FDA-approved technique where the tissue is injected with saline to create a cushion in the deeper layers. The superficial layer is then ablated with argon plasma coagulation (a form of heat therapy). Preliminary studies show this can be very useful when other methods are failing.
• Esophagectomy. In rare cases, a surgical procedure is used in which all or part of the esophagus and nearby lymph nodes are removed.

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