Barrett’s esophagus occurs when the esophagus is damaged by acid that has escaped from the stomach. Although anyone of any age can develop Barrett’s esophagus, it’s more common in men, older people, white people, the overweight, smokers and ex-smokers, and those with a hiatal hernia. The primary risk factor is chronic GERD (gastroesophageal reflux disease), particularly if you have suffered from GERD for over 10 years.
The acid that escapes from the stomach of a GERD sufferer can damage the lining of your esophagus because it’s not designed for such high levels of acidity. As your esophagus attempts to heal itself, repeated instances of acid reflux may cause it to adapt its cells to protect itself. The cells begin to resemble those of your intestine in a process called metaplasia: the reversible substitution of a distinct cell with a mature cell of another differentiated kind.
If your acid reflux is treated, your cells can return to their normal form but if not, these cell changes can develop into dysplasia (the earliest form of pre-cancerous lesions recognizable in a biopsy). There is also a small risk that these lesions may become cancerous.
What are the symptoms of Barrett’s esophagus?
Some people develop Barrett’s esophagus without having symptoms, but others will have the symptoms of the GERD that so often pre-empts the condition. These symptoms include:
- heartburn (a stinging or burning sensation near your heart, although you may feel this sensation anywhere between your stomach and throat)
- chest pain or pain down near your LES
- a sour taste on your tongue or sour liquid at the back of your throat
- the taste of regurgitated food
- dysphagia (difficulty swallowing)
- chronic cough
- hoarseness or sore throat
- feeling as though you have a lump in your throat
What is the medical treatment for Barrett’s esophagus?
Initially, the treatment for mild Barrett’s esophagus will be similar to the treatment for GERD, focusing on lifestyle changes and medications including, proton pump inhibitors, which reduce the production of stomach acid at a late stage by shutting down the ‘pumps’ in acid-producing cells.
In more severe cases, or cases where medication fails to facilitate healing of the esophageal lining, invasive techniques will be required. Options include:
- Radiofrequency ablation (RFA). An endoscope is inserted into your esophagus to accurately direct radio waves that destroy abnormal cells in the lining. The healthy cells below remain undamaged.
- Endoscopic spray cryotherapy. This technique uses extreme cold, delivering nitrogen or carbon dioxide gas through an endoscope to freeze the abnormal cells in your esophagus.
- Endoscopic mucosal resection (EMR). In this procedure, the abnormal lining of your esophagus is peeled away and removed via an endoscope.
- Photodynamic therapy (PDT). This procedure required you to take a special medication that can make cells light-sensitive. Then a laser, directed via an endoscope, is used to destroy abnormal cells in the esophageal lining while leaving healthy cells untouched.
- Removal of the esophagus. This surgery is only done in more serious cases, where severe precancer (dysplasia) or cancerous cells has been identified. The early removal of the majority of the esophagus provides the best chance for recovery.