The esophagus is the tube going from the mouth down to the stomach. Barrett’s esophagus (BE) is a change in the lining of the esophagus – it becomes more like the lining of the small intestine. BE is a complication of chronic acid reflux, or gastroesophageal reflux disease (GERD). These cause chronic inflammation in the area where the esophagus is joined to the stomach. Barrett’s esophagus affects approximately 100,000 people in the Chicago area.
Symptoms of Barrett’s esophagus
BE has no symptoms. Acid reflux does have symptoms – heartburn, difficulty swallowing, a feeling that food gets stuck, chest pain, bleeding, anemia, weight loss, coughing, hoarseness, and others. Some of these require immediate investigation by a doctor.
Causes of Barrett’s esophagus
The whole story is not known – acid is the suspected culprit, but other agents such as bile may be involved. The esophagus is not acid-resistant. It may respond to chronic acid exposure by becoming like the small intestine – called intestinal metaplasia – a change which may cause more harm than good. The next step is dysplasia (abnormal growth pattern), which is a precancerous condition. The only way to find dysplasia is with biopsies, under a microscope. Overall, the esophageal cancer risk in patients with BE is approximately 0.5 percent per year.
Risk factors for Barrett’s esophagus
- Chronic heartburn and acid reflux- symptoms of GERD for more than 10 years
- Men are more likely to develop Barrett’s esophagus
- More common in older adults, but it can occur at any age
Diagnosis of Barrett’s esophagus
Endoscopy with biopsies is currently the only way to check for BE, and for dysplasia
The American College of Gastroenterology (in 2015) stated that men with heartburn or acid reflux at least weekly for over 5 years should be considered for endoscopy to check for BE if they have two or more:
- Age over 50
- Central obesity (waist over 40 inches, or waist-hip ratio over 0.9
- History of smoking
- Family history of BE or esophageal cancer
Treatment of Barrett’s esophagus
Although the risk of esophageal cancer is small, monitoring of BE can be necessary. It is also important to control acid with medications, quit smoking, and lose weight. If precancerous cells are discovered, they can be treated, through procedures such as radiofrequency ablation, to prevent esophageal cancer. The use of these measures should be individualized to your situation.