Barrett's Esophagus

Signs & symptoms

Barrett's esophagus itself has no symptoms but its precursor, gastroesophageal reflux disease (GERD), does. Signs of GERD include regular heartburn, which is often described as a painful burning sensation either in the chest, behind the breastbone, or in the middle of the abdomen.

However, not all people with Barrett's esophagus have chronic heartburn. As many as half of all Barrett's esophagus patients don't have any symptoms at all. Because the condition can go undetected, it's good to know about other risk factors for Barrett's esophagus, which include:

• Obesity
• Smoking
• Gender (men are twice as likely as women to get Barrett's esophagus)
• Age (Barrett's esophagus is more common in people age 50 or older)
• A close family member with the condition

Diagnosis

Barrett's esophagus is diagnosed with an upper gastrointestinal (GI) endoscopy and biopsies.

To perform an upper GI endoscopy, a doctor threads a thin, flexible tube through the mouth, down the esophagus and into the stomach while the patient is lightly sedated. The endoscope has a flashlight and camera on one end that allows the doctor to inspect the esophageal lining for cellular changes that might indicate dysplasia. The doctor can also use the endoscope to take small tissue samples called biopsies. These samples help doctors diagnose the presence and grade of Barrett's esophagus.

New technologies also allow doctors to do optical biopsies, which don't involve removing any tissue at all.

The results may be labeled one of the following:

• No dysplasia, meaning the patient has Barrett's esophagus but no precancerous cellular changes
• Low-grade dysplasia, meaning cells show early signs of precancerous changes
• High-grade dysplasia, meaning cells are moving toward esophageal cancer

Treatments

Treatment of Barrett's esophagus depends on the condition's severity, the grade of dysplasia and the patient's overall health.

The first line of treatment is often surveillance and medication. If the biopsy shows no or even low-grade dysplasia, we may simply monitor the patient for changes. That may mean a follow-up endoscopy in six months to a year and, for some patients, daily medication.

For Bartlett's esophagus, the most common type of drug therapy is proton pump inhibitors, or PPIs. These medications are designed to treat GERD and work by suppressing the stomach's acid production. Less stomach acid means less damage to the esophagus. PPIs are best taken short term. Examples of common PPIs include:

• Omeprazole (Prilosec, Zegerid)
• Lansoprazole (Prevacid)
• Pantoprazole (Protonix)
• Rabeprazole (AcipHex)
• Esomeprazole (Nexium)
• Dexlansoprazole (Dexilant)

If GERD symptoms don't respond to medication or if the patient has high-grade dysplasia, the doctor may recommend an endoscopic procedure to remove or destroy the abnormal cells or dysplasia. The approach depends on the patient and how far the Barrett's esophagus has progressed. Three common procedures are:

• Esophageal mucosal resection: The doctor lifts the damaged tissue, injects a solution underneath to act as a cushion, and removes the affected tissue using a snare or suction cup.
• Endoscopic submucosal dissection: The doctor injects a solution under the targeted area, then dissects the area with a high-tech knife. This technique allows for the removal of larger and potentially deeper lesions.
• Radiofrequency ablation: This approach uses radio waves to heat and kill pre-cancerous and/or cancerous cells.

The last and final step for treating Barrett's esophagus is the surgical removal of the damaged sections of the esophagus, a procedure called esophagectomy. Afterward, the surgeon rebuilds the esophagus from part of the stomach or large intestine.