Barretts esophagus
Definition
Barrett's esophagus is a gastrointestinal disorder in which the lining of the esophagus (the tube that carries food from the throat to the stomach) is damaged by stomach acid that leaks backward.
See also: Gastroesophageal reflux disease (GERD)
Causes
Irritation of the lining of the esophagus by stomach acid can lead to Barrett's esophagus. The irritation is caused by stomach acid that leaks and moves back up the gastrointestinal tract. This is commonly known as gastroesophageal reflux (GERD) and it can cause heartburn.
Barrett's esophagus is more common in men than women. You have a greater risk for this condition if you have frequent and long-standing GERD.
Symptoms
Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus results in symptoms of heartburn.
Exams and Tests
Diagnosis involves looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination. This procedure is called an esophagoscopy with biopsy.
Follow-up endoscopy is often advised to look for complications such as cancer.
Treatment
Treatment may be important even if you do not feel any symptoms.
Lifestyle changes include:
- Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure and allow stomach acid to flow backwards
- Avoiding alcohol and tobacco
- Avoiding lying down after meals
- Losing weight
- Sleeping with the head of the bed elevated
- Taking all medications with plenty of water
Medications to relieve symptoms and control gastroesophageal reflux include:
- Antacids after meals and at bedtime
- Cholinergic agents
- Histamine H2 receptor blockers
- Promotility agents
- Proton pump inhibitors
Surgery to remove a portion of the esophagus may be recommended, if a biopsy shows cell changes that tend to lead to cancer. Such changes are called dysplasia.
Photodynamic therapy (PDT) is an option that may allow you to avoid surgery. PDT involves the use of a special laser device, called an esophageal balloon, along with a drug called Photofrin. Together, the laser balloon and medication lead to destruction of the abnormal cells lining the esophagus, without affecting the normal tissue.
Outlook (Prognosis)
An increased risk of esophageal cancer is present. Follow-up endoscopy to look for dysplasia or cancer is often advised.
Possible Complications
Persons with this condition havean increased risk for esophageal cancer. If cancer develops, symptoms may include difficulty swallowing or weight loss. See: Esophageal cancer
When to Contact a Medical Professional
Call your health care provider if heartburn persists for longer than a few days, or you have pain or difficulty swallowing.
Call your provider if you have been diagnosed with Barrett's esophagus and your symptoms get worse or do not improve with treatment, or if new symptoms develop.
Prevention
Diagnosis and treatment of GERD may prevent Barrett's esophagus.
References
Wilson, J F. In the clinic. Gastroesophageal reflux disease. Ann Intern Med. 2008; 149(3):ITC2-1-15; quiz ITC2-16.
Wang, K K and Sampliner, R E. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103(3): 788-97.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
