Anyone can develop Barrett’s esophagus, but people with heartburn are three to five times more likely to do so. Barrett’s esophagus affects about 700,000 adults in the United States; the average patient is 60 years old. Twice as many men as women have it, and white men have it much more than men of other races.No one knows exactly what causes Barrett’s esophagus, but it may be related to gastroesophogeal reflux disease (GERD). GERD, or chronic heartburn, occurs when stomach contents are regurgitated back into the esophagus. Over time, stomach acid can damage the esophagus lining and, eventually, change the tissue. The process of tissue change is called "intestinal metaplasia."
This condition often has no symptoms. When symptoms do occur, they include:
waking during the night because of heartburn pain
vomiting
blood in vomit or stool
difficulty swallowingComplications
About 5-10 percent of people with Barrett’s esophagus develop a rare type of cancer called esophageal adenocarcinoma. The risk of developing this cancer is 30 to 125 times higher in people who have Barrett’s esophagus than in those who do not. This cancer is increasing rapidly, especially in white men, possibly related to the rise in obesity and GERD.
Another complication is called "strictures." Sometimes the damaged lining of the esophagus becomes thick and hardened, causing the esophagus to narrow and interfering with eating and drinking. This condition is treated by dilation, in which an instrument gently stretches the lining, expanding the opening in the esophagus.
There is no treatment for Barrett’s esophagus short of surgery to remove the esophagus. This is an extreme measure, and is recommended only in someone with very high risk of cancer or someone who has cancer already. Usually, doctors recommend that patients treat the underlying GERD with acid-blocking drugs. This sometimes improves the Barrett’s, but there is no evidence that it reduces the risk of cancer. Medications that may help GERD include:
H2 blockers, like cimetidine, ranitidine, and famotidine
proton pump inhibitors, like omeprazole and lansoprazoleScreening for cancer
Once Barrett’s esophagus is diagnosed, it is recommended that patients undergo periodic endoscopies to screen for cancer. However, the endoscopy alone cannot detect whether the cells are cancerous; the physician must take multiple biopsies, and even then he or she could miss the cancer. There are no commonly accepted guidelines for how often these screenings should take place, but a good rule of thumb is that the frequency of screening endoscopies increases with the severity of the Barrett’s esophagus. For example, many gastroenterologists will perform endoscopies with biopsy every 3 months for severe disease versus once a year for mild disease.
Surgery
When esophageal adenocarcinoma is detected, or when there is a high risk of developing it, you may wish to undergo surgery. The surgery usually involves removing most of the esophagus and pulling the stomach up to attach it to the remaining esophagus.
Some elderly patients have other medical conditions that make surgery too risky or diminish its benefits. Alternative methods of treatment are currently being investigated.
