Barrett's Esophagus: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Barrett's esophagus is a condition in which acid reflux damages the flat pink lining of the esophagus, the esophagus that carries food from the mouth to the stomach, causing the lining to thicken and turn red.

Between the esophagus and the stomach, there is a valve called the lower esophageal sphincter, or LES. The LES degenerates over time, which can result in acid and chemical damage to the esophagus, which is what causes the gastroesophageal reflux disease (GERD) problem. Heartburn and regurgitation symptoms are frequent with GERD. 

Barrett's esophagus is associated with an increased chance of developing esophageal cancer. Despite the low risk of developing esophageal cancer, it is essential to have regular exams that involve in-depth imaging and extensive esophageal biopsies to check for precancerous cells (dysplasia). Precancerous cells can be treated if they are discovered in order to prevent esophageal cancer.

Causes Of Barrett's Esophagus

What causes Barrett's esophagus is unknown. While many people with Barrett's esophagus have had GERD for a long time, many others experience "silent reflux," which is reflux without any symptoms.

Whether or not GERD symptoms also accompany acid reflux, chemicals, and stomach acid go back into the esophagus, eroding the tissue and causing alterations to the lining of the esophagus that results in Barrett's esophagus.

Symptoms Of Barrett's Esophagus

Chronic GERD is the most common cause of Barrett's esophagus and might present as any of the following symptoms and signs:

• Recurrent heartburn and regurgitation of stomach contents
• Difficulty eating food
• Sometimes, chest pain

It's unusual that only around half of people with Barrett's esophagus seem to experience severe acid reflux symptoms. You should therefore discuss your digestive health and the possibility of Barrett's esophagus with your doctor.

Risk factors Of Barrett's Esophagus

The following factors make you more likely to get Barrett's esophagus:

• Family history: Your risk of getting the ailment rises if you have a family history of Barrett's esophagus or esophageal cancer.
• Gender: In men, Barrett's esophagus is far more typical.
• Race: White people are more prone to get the disease compared to people of other races.
• Age- Barrett's esophagus can occur at any age, however, people over 50 have a higher risk of developing it.
• Chronic heartburn and acid reflux: The use of proton pump inhibitors for GERD that does not go better or that requires continued treatment can both increase the chance of developing Barrett's esophagus.
• Smoking
• Obesity: Obesity in your abdomen increases your risk much more.

Diagnosis Of Barrett's esophagus

An endoscopy is frequently used to identify Barrett's esophagus.

An endoscope, an illuminated tube with a camera at the end, is used to inspect your throat in order to check for any signs of shifting esophageal tissue. Normal esophageal tissue appears to be bright and glossy. Barrett's esophageal tissue is silky and red.

Your doctor will take a biopsy of your esophagus. The tissue from the biopsied area can be examined to gauge the degree of alteration.

Determining the severity of tissue changes

The degree of dysplasia in the cells of your esophagus is assessed by a pathologist, a doctor who specializes in examining tissue in a lab. Having two pathologists, at least one of whom should be knowledgeable in gastrointestinal pathology, validate your diagnosis of esophageal dysplasia is the best method to ensure accuracy. You can classify your tissue as:

• There is zero dysplasia if Barrett's esophagus is present but the cells do not exhibit precancerous changes.
• If cells show only mild signs of precancerous changes and low-grade dysplasia.
• High-grade dysplasia is the result of many cell changes. High-grade dysplasia is thought to be the last stage before esophageal cancer cells develop.

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Treatment Of Barrett's Esophagus

How you are treated for Barrett's esophagus depends on the extent of the abnormal cell growth in your esophagus and your general health.

Zero dysplasia

Most likely, your physician will suggest:

• Routine endoscopy to assess the condition of your esophagus's cells. If your biopsies do not show dysplasia, you will likely have a follow-up endoscopy in a year, and if no changes occur, every three to five years.
• The treatment for GERD. Medication and lifestyle changes might help to minimize your indications and symptoms. Surgery or endoscopic methods may be an alternative to treat a hiatal hernia or to tighten the lower esophageal sphincter, which controls the flow of stomach acid.

Low-grade dysplasia

It is believed that low-grade dysplasia is the first step of precancerous changes. A qualified pathologist should confirm the presence of low-grade dysplasia if it is found. For low-grade dysplasia, your doctor could advise having another endoscopy in six months, followed by follow-up screenings every six to 12 months.

However, considering the risk of esophageal cancer, treatment may be suggested if the diagnosis is confirmed. Suggested treatments include:

• Endoscopic resection uses an endoscope to remove damaged cells, which aids in the detection of dysplasia and cancer.
• Radiofrequency ablation uses heat to eliminate abnormal esophagus tissue. It might be suggested to do radiofrequency ablation after endoscopic resection.
• Cryotherapy uses an endoscope to deliver a chilly liquid or gas to abnormal esophagus cells. The cells are refrozen after being given time to warm up. This method helps to kill the abnormal cells of the esophagus.If there is still significant esophageal inflammation discovered after the initial endoscopy, it is performed again after three to four months of medication to reduce stomach acid.

High-Grade dysplasia

There is general agreement that high-grade dysplasia precedes esophageal cancer. For this reason, your doctor might advise cryotherapy, radiofrequency ablation, or endoscopic excision. The damaged piece of your esophagus may be surgically removed, and the remaining segment may be connected to your stomach.

Barrett's esophagus could come back after treatment. How frequently you need to come back for additional testing should be determined by your doctor. If you choose a course of therapy other than surgery to remove abnormal esophageal tissue, your doctor will probably suggest lifetime medication to lessen acid and promote the healing of your esophagus.

Complications Of Barrett's Esophagus

Barrett's esophagus patients are more likely to get esophageal cancer. The risk is negligible, even in patients whose esophagus cells have undergone precancerous mutations. Fortunately, persons with Barrett's esophagus seldom develop esophageal cancer.

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