Barrett’s esophagus

"I would like to find a stew that will give me heartburn immediately, instead of at three o clock in the morning." - John Barrymore, actor

Barrett’s esophagus is a condition in which the tissue lining the esophagus, the tube connecting the mouth to the stomach, is replaced by tissue similar to the lining of the intestine due to frequent exposure to stomach acids from Acid Reflux (see GERD). Barrett’s esophagus affects about 1% of adults in America; most commonly older, white, males. A small number of people with Barrett’s esophagus develop a rare but deadly type of cancer.

Barrett’s esophagus can only be diagnosed using an upper gastrointestinal (GI) endoscopy to obtain biopsies. After the patient is sedated, a doctor inserts a flexible tube (an endoscope) with a light and miniature camera down the throat. If esophagus tissue looks suspicious, several small pieces are removed using the endoscope. A pathologist examines the tissue with a microscope to determine the diagnosis.

If you’re told you have Barrett’s esophagus, here are some questions from the Mayo Clinic to ask your doctor

■Does my pathology report show dysplasia (i.e. cell change)? If so, what is the grade of my dysplasia? High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.
■Were my biopsy samples examined by a gastroenterological pathologist? Did two or more pathologists agree on the diagnosis?
■How much of my esophagus is affected by Barrett's dysplasia?
■Will I need to undergo another endoscopy exam to confirm my diagnosis?
■What is my risk of esophageal cancer?
■What are my options for reducing my risk of esophageal cancer?
■What are my treatment options for Barrett's esophagus?
(Removing damages cells via endoscope or surgery, using heat or light to kill bad cells)
■What are the benefits and risks of each treatment option?
■Do I have to have Barrett's esophagus treatment? What happens if I choose not to have treatment?
■Should I see a specialist? What will that cost, and will my insurance cover it?
■Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

Bottom Line

Fortunately the odds of cancer from Barrett’s esophagus is less than 1% per year. However it’s not uncommon for esophagus cancer to show no new symptoms not already experienced with GERD. By the time it’s detected through symptoms alone, the cancer is advanced and untreatable and leads to death. Late stage symptoms include difficulty swallowing, vomiting red blood or blood that looks like coffee grounds, passing black, tarry or bloody stools.

Persons with a history of GERD over many years should be examined via GI endoscopy. And if Barrett’s esophagus is diagnosed, schedule an annual GI endoscopy to look for cancer. Also change your lifestyle to minimize the occurrences to GERD to avoid damaging more of the esophagus. See my post on GERD for more details.

Resources

http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/
http://www.mayoclinic.com/health/barretts-esophagus/hq00312
http://www.gicare.com/diseases/barrett-esophagus.aspx
http://en.wikipedia.org/wiki/Barrett