Barrett's Esophagus

GENERAL INFORMATION:

What is Barrett esophagus?

• Barrett esophagus, or BE, is also called columnar-lined esophagus. The esophagus is the tube that carries food and liquid from the throat to the stomach. Barrett esophagus is a type of precancerous disease that affects and damages the esophagus. Precancerous means that it may lead to cancer (tumor). Normally, cells reproduce by splitting in a planned way, making more cells only when needed. With Barrett esophagus, normal cells lining the esophagus may have had an injury that caused inflammation (swelling) and damage. When the damaged areas heal, abnormal cells grow and divide without order, and replace the normal cells. This process may later lead to esophagus cancer.
  
  
• A Barrett esophagus may have a long or a short segment (piece). This is based on the length of abnormal tissue starting from the gastroesophageal junction. The gastroesophageal junction is the area where the esophagus and stomach meet. A long-segment BE has abnormal tissue that measures three centimeters or more from the gastroesophageal junction. Abnormal tissue that measures less than three centimeters is considered a short-segment BE. Diagnosing and treating Barrett esophagus as soon as possible may prevent it from becoming cancer.

What causes Barrett esophagus? The exact cause of Barrett esophagus is not known. Caregivers believe that Barrett esophagus is related to long-standing gastroesophageal reflux disease (GERD). GERD occurs when you have a weak lower esophageal sphincter. A sphincter is a ring-like muscle that opens and closes an opening in your body. If the sphincter relaxes too often, it causes stomach acid to reflux (back up) into the esophagus. This acid irritates and damages the esophagus, which may later lead to abnormal changes in the cells lining the esophagus. The following are other possible conditions and factors that may increase your risk of having Barrett esophagus:

• Age: The incidence of Barrett esophagus increases with age. Men above 40 years of age are usually affected.
  
  
• Family history: Having a close family member with GERD, Barrett esophagus, or esophageal cancer.
  
  
• Obesity: Weighing more than what your caregiver suggests may put pressure on your stomach. This pressure causes stomach acid to reflux into the esophagus.
  
  
• Unhealthy lifestyle: Some caregivers think that smoking cigarettes and drinking alcohol may also cause Barrett esophagus.

What are the signs and symptoms of Barrett esophagus? Signs and symptoms of Barrett esophagus are usually related to GERD signs and symptoms. Heartburn, the most common symptom of GERD, may also be present in Barrett esophagus. It is a feeling of burning pain in your chest or below the sternum (chest bone). This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have any of the following:

• Bitter or acid taste in your mouth.
  
  
• Choking, coughing, or shortness of breath.
  
  
• Frequent burping or hiccups.
  
  
• Pain or trouble while swallowing.
  
  
• Vomiting (throwing up) blood or having black, tarry stools.
  
  
• Weight loss.

How is Barrett esophagus diagnosed?

• Your caregiver will need to do an endoscopy to diagnose Barrett esophagus. During an endoscopy, a scope is used to see the inside of your esophagus and stomach. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures that may be seen on a TV-like screen. A biopsy, where samples are taken from your esophagus and sent to a lab for tests, may also be done. These tests will show if the samples have dysplasia. Dysplasia is a condition where cells and tissues show abnormal changes. Your caregiver will need to check your Barrett esophagus dysplasia to tell you its grade.
  
  
• The grade of Barrett esophagus will tell how much abnormal change is present in your esophagus. Abnormal changes may range from negative (no dysplasia) to high-grade (a large amount of) dysplasia. In high-grade dysplasia, the esophagus cells may look the same as cancer cells. The more cells that have dysplasia, the greater the risk of cancer.

How is Barrett esophagus treated? Treatment for Barrett esophagus depends on its grade. It includes controlling your symptoms and preventing esophageal cancer. Your caregiver may suggest that you make diet and lifestyle changes, such as losing weight. You may also need any of the following:

• Medicines: Medicines may be given to relieve the symptoms caused by Barrett esophagus. Anti-reflux medicines help decrease the stomach acid that can irritate your esophagus and stomach. These medicines may include proton pump inhibitors (PPI) and histamine type-2 receptor (H2) blockers. You may also be given medicines to stop vomiting.
  
  
• Surgery: Surgery may be done when your medicines cannot control your symptoms or other problems, such as high-grade dysplasia, are present. Your caregiver may also suggest surgery depending on the type of Barrett esophagus that you have. Surgeries may include the following:
  
  
  • Fundoplication: Fundoplication is a surgery that wraps the upper part of the stomach around the esophageal sphincter to strengthen it. Strengthening the sphincter may help to prevent reflux. Ask your caregiver for more information about fundoplication.
    
    
  • Resection or esophagectomy: Your caregiver may remove a part of or the entire esophagus.
  
  
• Other treatments: Ask your caregiver about the following treatment options for Barrett esophagus.
  
  
  • Ablation: Barrett esophagus may be treated by using a special thermal (heat) ultrasound or freezing ablation treatment.
    
    
  • Photodynamic therapy: Lasers, in combination with medicines that become active when exposed to light, are used to destroy abnormal cells.

Where can I find support and more information? Having Barrett esophagus may be life-changing for you. You and those close to you may feel scared, sad, or anxious. These are normal feelings. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• National Digestive Diseases Information Clearinghouse (NDDIC)
  2 Information Way
  Bethesda, MD 20892-3570
  Phone: 1-800-8915389
  Web Address: www.digestive.niddk.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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