Barrett’s esophagus is a disorder in which the lining of the esophagus is damaged by stomach acid. People with Barrett’s esophagus have an increased risk for cancer in the area involved. However, cancer is not common.
When you eat, food passes from your throat to your stomach through the esophagus. A ring of muscle fibers in the lower esophagus keeps stomach contents from moving backward.
If these muscles do not close tightly, harsh stomach acid can leak into the esophagus. This is called reflux or gastroesophageal reflux (GERD). It may cause tissue damage over time. The lining becomes similar to that of the stomach.
Barrett’s esophagus occurs more often in men than women. People who have had GERD for a long time are more likely to have this condition.
Barrett’s Esophagus Symptoms
Barrett’s esophagus itself does not cause symptoms. The acid reflux that causes Barrett’s esophagus often leads to symptoms of heartburn. Many people with this condition do not have any symptoms.
Barrett’s Esophagus Diagnosis
You may need an endoscopy if GERD symptoms are severe or come back after treatment.
During the endoscopy, your health care provider may take tissue samples from different parts of the food pipe. These biopsies help diagnose the condition. They also help look for changes that could lead to cancer.
Your provider may recommend a follow-up endoscopy to look for cell changes that indicate cancer. People with Barrett’s esophagus are recommended to have follow-up endoscopy every 3 to 5 years, or more if abnormal cells are found.
Barrett’s Esophagus Treatment
Until very recently patients with Barrett’s esophagus with high or low grade dysplasia had two treatment options: continued endoscopic surveillance (“watchful waiting”) or esophagectomy.
For many patients these treatment options seemed at opposite ends of the treatment spectrum, and neither seemed appropriate for a pre-cancerous condition.
Over the past several years, there has been increased interest in endoscopic ablation or removal of dysplastic Barrett’s esophagus. These procedures have focused on removing all or most of the Barrett’s esophagus (and therefore reducing the risk of cancer) in a safe and relatively non-invasive way.
The most promising technology is radiofrequency ablation. This innovative system uses a flexible catheter with small electrodes on the end which can be guided endoscopically into the esophagus and used to ablate or burn the Barrett’s esophagus. Energy delivery is precisely controlled by a radiofrequency generator, so only the epithelial lining of the esophagus is ablated.
The management of Barrett’s with dysplasia is complex and must be individualized for each patient. Patients referred to Wake Forest Baptist are invited to an initial office consultation where they are educated about their risk for developing esophageal cancer and presented with all the treatments options.
Patients who choose radiofrequency ablation first undergo an initial endoscopic ultrasound (EUS) as well as extensive endoscopic biopsies and, if needed, endoscopic mucosal resection (EMR) of any nodular tissue within the Barrett’s.
Assuming no adenopathy or esophageal wall abnormalities are seen on EUS, the Barrett’s esophagus will be ablated. This outpatient endoscopic procedure is performed with monitored anesthesia care. Patients typically go home the same day. Several ablation sessions are needed usually 2-3 months apart with a goal of complete eradication of Barrett’s esophagus.