Barrett’s esophagus was named after Norman Barrett, who described the condition in 1950. “Barrett’s esophagus is a change in the normal tissue in the esophagus,” said Dr. Lisbeth Selby, a gastroenterologist at the University of Kentucky Hospital. “The tissue it changes into is precancerous.”
“Barrett’s esophagus is a condition where the normal epithelium that lines the esophagus is replaced with an abnormal epithelium that’s called metaplastic tissue,” said Dr. Stephen Schindler with Colorectal Surgical & Gastroenterology Associates, PSC. “This predisposes patients to developing adenocarcinoma of the esophagus.” The esophagus is essentially trying to protect itself from stomach acid by changing the tissue. “Instead, it replaces it with a tissue that is metaplastic, and that type of tissue can cause cancer,” Schindler said.
Similar to the way moles or colon polyps can be precancerous, having Barrett’s esophagus does not mean the patient has cancer. “It is thought to be a precursor but it is not automatic,” Selby said. “Only a minority of people that have Barrett’s esophagus get cancer.”
“It’s felt that this is a consequence of chronic acid reflux, so that predisposes a person to developing Barrett’s esophagus,” Schindler added.
Barrett’s esophagus is most commonly found in middle-aged white males. Men are thought to develop it twice as often as women. While the average age of diagnosis is 50 years, the incidence increases as patients get older and have more acid reflux.
Barrett’s esophagus is hard to diagnose because the condition itself offers no symptoms. “There are symptoms related to what is thought to be the precursor of Barrett’s esophagus – acid reflux, a mid-chest burning or a feeling of something rising into the chest,” said Selby. “Barrett’s esophagus is often found in the course of performing an upper endoscopy for a symptom.”
“When we see irregularities at the gastro-esophageal junction, where the stomach and the esophagus meet, that makes us think of Barrett’s,” Schindler said. A biopsy is usually performed to ascertain the presence of the condition. Intestinal metaplasia generally indicates Barrett’s esophagus.
Treating symptoms of GERD with acid-reducing drugs such as prevacid and prilosec decreases the patient’s odds of getting Barrett’s esophagus. If medications are not effective in treating GERD, a surgical procedure may be indicated.
“A patient with Barrett’s esophagus can have low-, medium- or high-grade dysplasia,” Schindler said. “For patients with high-grade dysplasia, that means they’re one step away from getting cancer. So at that point you basically have to do something invasive. You either have to remove that portion of the esophagus or you have to utilize one of the newer therapies that are just coming out.”
Radio-frequency ablation is a common treatment for high-grade dysplasia. “It uses radio waves to cause a chemical burn to that area,” Schindler said. “There’s another treatment called photodynamic therapy. A drug is placed in the area. A laser activates the drug, and that burns the area.” Patients with low-grade or no dysplasia do not have to go through such aggressive therapies, but they may have to undergo more frequent upper endoscopies to keep tabs on the progression of the disease.
Management of Barrett’s esophagus once it is found is controversial. “It puts a patient on a program of checkups, including periodic endoscopy,” Selby said. “It is expensive and invasive to do upper endoscopy to follow up on Barrett’s.”
Researchers are continuing their quest to find clues for decreasing patients’ risk of Barrett’s esophagus and esophageal cancer. “There are interesting findings coming out,” Selby said. Some of it is the old “tried and true,” such as maintaining a healthy weight and avoiding smoking. The National Institute for Diabetes and Digestive and Kidney Diseases and the National Cancer Institute both sponsor research programs that are looking into Barrett’s esophagus and esophageal cancer. These programs include establishing additional tests to identify people with the condition; identifying the cause; studying the long-term effectiveness of treatments; and developing additional non-surgical treatments for individuals with Barrett’s esophagus or esophageal cancer.
“Not everybody that refluxes gets Barrett’s esophagus, and not everybody that has Barrett’s esophagus develops cancer,” Schindler said. “That’s why the screening protocols are very important.”
By Jamie Lober, Staff Writer
Additional supporting by Tanya J. Tyler