The normal esophagus is lined by cells that resemble skin called squamous epithelium. In some people, who have long standing Gastroesophgeal Reflux disease (GERD), chronic irritation caused by acid reflux causes squamous epithelium to change into a lining that resembles small intestinal mucosa. This change is called metaplasia. This change is generally seen at the lower end of the esophagus above the valve between the esophagus and stomach (Lower Esophageal Sphincter) and this metaplastic lining is known as Barrett’s Esophagus.
What is the incidence of Gastroesophageal Reflux and Barrett’s Esophagus?
The incidence of GERD in the United States is estimated to be 15% and about 5% of these patients may have Barrett’s Esophagus (1% of the population).
Why is important to detect Barrett’s Esophagus?
Several studies have shown that up to 5% of patients with Barrett’s esophagus may develop adenocarcinoma, a form of esophageal cancer.
How is Barrett’s Esophagus detected?
Upper Endoscopy is the only reliable way of detecting Barrett’s Esophagus. The normal squamous lining of the esophagus appears pale pink in color but the metaplastic Barrett’s epithelium appears to be salmon (reddish) color that can be best seen under special blue light. Biopsies confirm the diagnosis and can determine if there is dysplasia (change to abnormal cells that can lead to cancer).
What to do once Barrett’s Esophagus is detected?
Barrett’s Esophagus is caused by GERD and the best way to prevent is to treat the underlying cause aggressively using Proton Pump Inhibitors (Prilosec, Nexium, Prevacid, Protonix etc). Once Barrett’s develops, medical therapy will not make the Barrett’s regress or resolve but may prevent progression of the length of the Barrett segment.
Patients with long standing GERD need an index Endoscopy to determine if they have Barrett’s. Once Barrett’s is confirmed, they need surveillance endoscopy every 1-3 years to detect dysplasia.
How is Barrett’s esophagus treated?
- Medical management: Proton Pump Inhibitors will not make Barrett’s go away but may prevent progression and certainly help the underlying GERD.
- Endoscopic Management:Several methods are available but at this time Endoscopic treatment is generally reserved for those patients with dysplastic Barrett.
- Photodynamic Therapy: Light sensitizing agents are administered and laser light is used in the Barrett’s segment that causes the abnormal cells to be burnt.
- RadiofrequencyAblation: (Barryx Procedure) Radiofrequency waves are used to generate the heat and kill the abnormal cells.
- Endoscopic Mucosal Resection: A special cup is attached to the tip of the endoscope and the abnormal area suctioned into the cup and then resected using a hot snare
- Surgery: This involves resection of the Dysplastic Barrett segment and can be done laparoscopically.