Going for the Throat: Barrett’s Esophagus

Barrett’s Esophagus is a gastrointestinal condition that can strike without symptoms—and may even serve as a precursor to esophageal cancer. Shireen Pais, MD, Director of Endoscopic Ultrasound at Westchester Medical Center, sheds light on Barrett’s and how it can be treated.

What is Barrett’s Esophagus, and what are its causes?

Barrett’s Esophagus is a condition where adult cells in the esophagus transform into abnormal cells, or “metaplasia,” that increase the chance of turning into cancer.  In the esophagus, substances like acid and bile can irritate and inflame the cells in the lining. In most patients, more cells grow to replace the damaged ones. In some cases, however, the cells that grow resemble those in the intestinal lining. This is in some ways protective, as these cells are more resistant to injury from reflux. But theses changes may progress to dysplasia—pre-cancer—and ultimately esophageal cancer.

Am I at risk?

Caucasian males over 50 and those with long-standing symptoms of GERD, or gastroesophageal reflux disease, are at risk, and smoking, hiatal hernias, a family history of Barrett’s or esophageal cancer and obesity all  increase risk.

Could my acid reflux and heartburn cause Barrett’s? 

Heartburn and acid reflux raise the risk of developing Barrett’s to as high as 20 percent. Yet up to 44 percent of Barrett’s patients report no previous GERD symptoms.

What other symptoms might mean I have Barrett’s? 

Barrett’s itself has no symptoms. Among those with GERD symptoms—heartburn, belching, chest pain—Barrett’s can develop within one year. Additionally, if an endoscopy reveals ulcers or other changes in the esophagus, Barrett’s is five times more likely to develop. Painful or difficult swallowing, blood in vomit or stools, anemia, or weight loss requires immediate attention.

Can my diet place me at risk? 

Spicy or fatty foods, caffeine, soda, alcohol, peppermint, chocolate and cigarettes should be avoided if they trigger GERD symptoms, as treating GERD may reduce the risk of progression to Barrett’s.

How is Barrett’s diagnosed? 

The gold standard is an upper endoscopy procedure with targeted biopsies of areas that appear nodular, ulcerated, or look atypical. Tools like magnification, dyes and blue-light imaging all help characterize damage.

Does a diagnosis mean I’m likely to get cancer?

The risk of esophageal cancer among Barrett’s patients is up to 40 times higher than normal; but at 0.6 percent per year, their risk remains low. Subjects with no dysplasia have extremely low cancer rates, whereas high-grade dysplasia means rates as high as 10 percent per year. Ablation therapy has been shown to eliminate precancerous cells, preventing cancer; it can also treat early esophageal cancer without the need for surgery.

Is there a treatment for Barrett’s? 

With the increased incidence of Barrett’s and exponential rise of esophageal cancer, several therapies now exist. Often it’s a combination of strong acid-reflux management, lifestyle modifications and cutting-edge endoscopic treatments such as those at Westchester Medical Center, which eliminate damaged tissue in a process called ablation. The theory is that destruction of tissue, combined with vigorous acid suppression and high-dose proton pump inhibitors, leads to a regeneration of the squamous cells, and thus a reverse course from Barrett’s back to normality. In cases of dysplasia, the physician excises the visible
lesions and follows with radiofrequency ablation. •

If you’re having GERD symptoms, contact Westchester Medical Center at www.westchestermedicalcenter.com/gastroenterologyservices.