What is Barrett’s Esophagus?
Barrett’s esophagus is when normal healthy cells in the esophagus are replaced by cells similar to those seen in the stomach and intestines. These cells are metaplastic (an abnormal change in the nature of the tissue) and can progress to dysplastic (pre-cancerous) or even esophageal cancer. The most common predisposing factor is gastroesophageal reflux disease (GERD). Not all patients will progress, but routine monitoring is recommended in order to find dysplastic changes early so your gastroenterolgist can intervene to halt its progression.
Risk factors for Barrett’s: Chronic reflux, obesity, family history of Barrett’s and adenocarcinoma of the esophagus, tobacco smoking, white men over 50 years old.
How is Barrett’s Esophagus Diagnosed?
In order to diagnose Barrett’s esophagus, an upper endoscopy must be performed. During this test, a small tube called an endoscope will be inserted into the throat and esophagus to look for changes in the esophageal lining. Healthy tissues will appear pale and glossy, while Barrett’s esophagus causes tissues to appear red and velvety. Small samples of tissue called biopsies will be taken, which will be examined by a pathologist in order to determine a diagnosis. The pathologist will look to see if your tissues contain abnormal cells, which is called metaplasia. Your samples will be classified as one of the following:
No Dysplasia
Barrett’s esophagus is present, but there are no signs of precancerous cells or changes in the cells.
Low-Grade Dysplasia
Small signs of precancerous changes were detected in the cells.
High-Grade Dysplasia
More significant precancerous changes were detected. These patients are at the highest risk of developing esophageal cancer.
Barrett’s Esophagus Treatment Options
All patients with Barrett’s are encouraged to manage their lifestyle risk factors such as smoking cessation, and weight loss. Excellent reflux control is important and may include medications.
Further therapy depends on whether dysplasia is present. Often other factors such as length of Barrett’s, age and family history are often factored into these decisions.
No Dysplasia
Patients with Barrett’s but no dysplasia are typically followed with periodic endoscopy tests in order to pick up any advancement of the disease.
Low-Grade Dysplasia
If patients have progressed to low-grade dysplasia treatment options may also include endoscopic resection and radio-frequency ablation in addition to close monitoring.
High-Grade Dysplasia
Patients with high-grade dysplasia are at particularly high risk of developing esophageal cancer. Your doctor may perform endoscopic resection, or radio-frequency ablation. In some cases surgical removal of diseased esophageal tissue may be recommended.
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