Barrett's esophagus is a condition in which the lining of the esophagus (the muscular tube connecting mouth to stomach) is replaced by tissue that is similar to the lining of the intestine. This is known as intestinal metaplasia.
About one percent of adults in the United States have Barrett’s esophagus. The average age of diagnosis is 50 years of age. Twice as many men as women develop Barrett’s esophagus, and Caucasian men are affected more frequently than men of other races.
GERD and Barrett’s esophagus
What causes Barrett’s esophagus is not fully understood, however, GERD is a risk factor for the condition. While some people without GERD do get Barrett’s esophagus, it is three to five times more likely to occur in people who also have GERD.
Less than one percent of people diagnosed with Barrett’s esophagus will develop esophageal cancer. A patient may have Barrett’s esophagus for several years before they develop esophageal adenocarcinoma.
If you have GERD or Barrett’s esophagus, your physician may advocate periodic examinations with biopsies taken to look for any early warning signs of cancer. Usually, precancerous cells will appear in the Barrett’s tissue before esophageal cancer develops. This condition is known as dysplasia, and will be revealed through biopsies of esophageal tissue.
Early detection and treatment of dysplasia may help prevent the development of esophageal cancer.
Barrett’s esophagus causes no symptoms. It can only be diagnosed by means of an upper endoscopy to obtain a biopsy of esophagus tissue.
While you are sedated, a tiny lighted camera on the end of a flexible tube (endoscope) is inserted into your throat. Tiny tweezers (forceps) may be used to sample esophageal tissue. This tissue will be examined later by a pathologist to determine if the cells are abnormal.
Barrett’s esophagus will not go away on its own. It must be treated through endoscopic treatments or surgery. The goal of these procedures is to remove the Barrett’s cells and any dysplasia and cancer cells, encouraging normal esophageal tissue to grow back as the area heals.
There are several endoscopic therapies available for the treatment of severe dysplasia and cancer, including:
- Photodynamic therapy (PDT): PDT uses a light-sensitizing agent (Photofrin) and a laser to kill abnormal cells. Photofrin is injected into a vein and the patient returns 48 hours later. An endoscope is then inserted into the esophagus and the laser light activates the Photofrin, which then destroys the Barrett’s tissue.
- Endoscopic mucosal resection (EMR): EMR is a procedure in which the Barrett’s lining is lifted, and a solution is injected underneath it. The lining is then removed through the use of an endoscope. If an EMR is used to treat cancer, an endoscopic ultrasound is used to determine whether the cancer involves only the top layer of cells.
In some cases, the Barrett’s esophagus has caused severe dysplasia, or cancer is evident. Surgical options may be considered, if:
- Cancer has been diagnosed
- Dysplasia is serious
The most common procedure, an esophagectomy, involves the removal of most of the esophagus, pulling a portion of the stomach up into the chest, and attaching it to the remaining esophagus.