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What is Barrett's esophagus?
Barrett's esophagus is a change in the cells lining the esophagus at the junction of the stomach and the esophagus. It occurs more often in men than in women (3:1 ratio) and is more common in Caucasian Americans than African Americans. The prevalence increases with age; the average age at diagnosis is 55 years. Its importance lies in its predisposition to evolve into esophageal cancer.
What causes Barrett's esophagus?
Barrett's esophagus is thought to be a complication of gastroesophageal reflux disease, a condition in which acids from the stomach flow up into the esophagus (reflux).
What are the chances that a patient with gastroesophageal reflux disease will develop Barrett's esophagus?
Barrett's esophagus develops in about 10 to 20 percent of patients with chronic gastroesophageal reflux disease or in those patients with inflammation of the esophagus.
What is the likelihood that Barrett's esophagus will develop into cancer of the esophagus?
Although severe gastroesophageal reflux disease and Barrett's esophagus are known to be the greatest risk factors for the development of esophageal cancer, the exact amount of increased risk is debated. About 5 percent of people with gastroesophageal reflux disease develop Barrett's esophagus. Once Barrett's is definitively diagnosed, the risk of developing esophageal cancer is increased 30- to 125-fold, according to some studies. The incidence of Barrett's-related esophageal cancer is rising faster than any other cancer in the United States. The number of patients with Barrett's-related cancer tripled from 1976 to 1990 and has doubled again in the past decade.
How is Barrett's diagnosed?
Barrett's esophagus is best diagnosed by endoscopy with biopsy. Barium contrast radiography may be used because it can detect changes (such as a cobblestone effect) on distal esophageal mucosa, peptic strictures, or a solitary ulcer. The diagnostic accuracy of the double-contrast barium esophagram is 70 percent.
What is the treatment for Barrett’s?
Patients with Barrett's esophagus should be treated at the very least for gastroesophageal reflux disease. The minimal goal of reflux therapy in Barrett's is to heal erosions, a step necessary to prevent extension of the Barrett's esophagus. Patients with Barrett's should also be followed closely with periodic endoscopic evaluations to look for evidence of progression to adenocarcinoma (cancer). Because Barrett's usually evolves into cancer with increasing degrees of dysplasia, biopsies should be taken routinely. The presence and severity of dysplasia generally dictates how often the patient should be examined. Treating dysplasia—removing the damaged cells—is usually done by burning or freezing the damaged esophageal lining.
What is the prognosis for someone with Barrett’s? Can it be cured or just controlled?
Recent studies have demonstrated that under the right conditions—suppression of stomach acid and treatment of the esophageal lining—Barrett's esophagus can be made to regress. In a process referred to as ablation therapy, thermal injury to the Barrett's mucosa is intentionally produced during an endoscopy. Several treatment sessions may be required, but even long segments of Barrett's mucosa can be made to regress. However, patchy residual Barrett's mucosa may persist. It is unknown whether ablative therapy reduces the risk of cancer.