Barrett's esophagus

Do you suffer from frequent episodes of heartburn? Are your symptoms relieved by antacids or other drugs prescribed by your doctor for acid reflux? Maybe yes. But have you ever tried finding out the effects of this persistent acid reflux and the potential complications it can lead to in the long term?

Changes can occur in your esophageal lining due to chronic insult by acid reflux from your stomach predisposing you to a condition called as Barrett’s esophagus. The main reason that it's useful to know whether you have Barrett's esophagus is that this is a premalignant condition, which means that it places you at a higher than average risk of getting cancer. While an endoscopy with your doctor can help in the further evaluation, read on for a basic understanding of the condition.

Symptoms

These are a few symptoms which will let you know if you need to undergo further evaluation to diagnose if you have Barrett’s oesophagus.

  • Heart burn
  • Pain while swallowing
  • Unexpected weight loss
  • Blood in vomit
  • Black colored stools

Diagnosis

The condition can be diagnosed only by doing an upper gastrointestinal endoscopy. During the procedure you will be sedated. Your doctor would insert a flexible tube called an endoscope that has a light and a miniature camera, into the oesophagus. If your doctor suspects changes in the lining tissue he would do a biopsy (remove very small pieces using a pincher like device) through the endoscope. These tissue pieces are then sent further to a pathologist who examines them under a microscope.

Preventive measures

Your physician would advise you to take a few preventive measures. They are:

  • Adapt a healthy lifestyle
  • Quit smoking
  • Avoid drinking alcohol
  • Exercise
  • Avoid foods like caffeine, chocolate, peppermint that can worsen heartburn.
  • Avoiding lying down after meals
  • Drink plenty of water
  • Follow healthy diet

Risk factors

If you have been diagnosed with Barrett’s oesophagus your risk of developing oesophageal cancer is 40 times higher than in the normal person. However it is also true that less than 1% of patients with Barrett’s oesophagus are seen to develop cancer. If unfortunately you develop cancerous changes in the Barrett’s tissue, then your doctor will brief you on the endoscopic and surgical options available and help you in deciding the best option for you.

Treating the condition

Certain medicines called as proton pump inhibitors, antacids, H2 receptor blockers, and promotility agents can help in reducing the amount of acid in the stomach.

Your physician may recommend the option of surgery, if a biopsy shows cell changes that are likely to lead to cancer. These treatments use heat (as in radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (as in cryotherapy) or light and special chemicals (as in photodynamic therapy) to remove the harmful tissue in your oesophagus.

Points to remember!!!

  • Barrett’s oesophagus is developed in people suffering from gastroesophageal reflux disease for several years.
  • Use acid reducing drugs.
  • Barrett’s oesophagus can be only diagnosed by upper gastrointestinal endoscopy and biopsy.
  • Endoscopy and biopsy is of paramount importance in an attempt towards early detection and management of the condition.

Oesophagus is the medical term for the hollow muscular tube/ food pipe that goes from your throat to your stomach. When you swallow food or drink any liquids; it passes into your stomach through the oesophagus. The upper and lower ends of the tube are pinched together by muscles called as sphincters. When you swallow food these sphincter muscles relax and allow for food and water to pass to the stomach, and then they close back rapidly to prevent leaking of food, drink or acid from the stomach back into the oespohagus.

However, if the sphincter at the lower end of the oesophagus does not close properly or opens spontaneously for varying periods of time stomach contents and digestive juices (acid) rise into the oesophagus. The refluxed acid touches the lining of the oesophagus and causes a burning sensation that you experience as heartburn.

TWhen you suffer from persistent acid reflux/ gastroesophageal reflux disease (GERD) for several years, the acid can cause damage to the tissue lining the inside of the oesophagus. During the healing process normal tissue of the oesophagus (where it joins the stomach) gets replaced by tissue that looks similar to that lining your intestines. This medical condition is termed as Barrett’s oesophagus.

However, it is also true that not all patients with GERD develop Barrett’s oesophagus neither do all patients with Barrett’s oesophagus have GERD. Less than 1% of patients with GERD may develop this condition. It is not associated with any particular signs or symptoms other than heartburn, regurgitation of food, excess belching, and hoarseness of voice, sore throat, or chronic cough as seen in GERD. The condition gains importance as in a small number of people it is known to lead to a rare but often deadly type of oesophageal cancer.

If you are a man over 50 years of age with a history of acid reflux disease for more than 10 years you are at an increased risk of developing Barrett’s oesophagus. Smoking and obesity are also risk factors for the condition.

Abnormal tissue in the Barrett’s oesophagus can degenerate into a premalignant phase called as dysplasia that can further degenerate into cancer. If you have Barrett's esophagus it is therefore important that you consult your physician about undergoing endoscopy to evaluate for the risk or existence of cancer. You should have endoscopy performed every 1 to 3 years. A biopsy (section of tissue) may be taken for examination if there is suspicion of any abnormal changes in the cells. This surveillance is necessary because it is seen that before cancer develops precancerous cells appear in the Barrett’s tissue and your physician can warn you for any early signs of cancer. In the presence of abnormal cells suggestive of precancerous condition close surveillance with endoscopy every 3 to 6 months is recommended.