Understanding and Preventing
Barretts Esophagus

I thought I only had Heartburn!

Do you know what Barretts Esophagus is? Most people have not heard of it. This disease is actually a condition that may develop in people who have chronic gastroesophageal reflux disease (GERD) or inflammation of the esophagus (esophagitis). Normal cells that line the esophagus are called squamous cells. In Barretts Esophagus, the squamous cells turn into a type of cell called specialized columnar cells. Damage to the lining of the esophagus, for example, by acid reflux from GERD, causes these abnormal changes.

People who have had regular or daily heartburn for more than 5 years may be at risk and should discuss the possibility with their doctor. Symptoms include waking during the night because of heartburn pain, vomiting, blood in vomit or stool, and difficulty swallowing. Some people do not have symptoms.

Diagnosis involves an endoscopy to look at the lining of the esophagus and a biopsy to examine a sample of tissue. To do an endoscopy, the doctor gently guides a long, thin tube called an endoscope through the mouth and into the esophagus. The scope contains instruments that allow the doctor to see the lining of the esophagus and to remove a small tissue sample, called a biopsy. The biopsy will be examined in a lab to see whether the normal squamous cells have been replaced with columnar cells.

Once cells in the lining of the esophagus have turned into columnar cells, they will not revert back to normal. In other words, at this time, there is no cure for Barrett's esophagus. The goal of treatment is to prevent further damage by stopping any acid reflux from the stomach. Medications that are helpful include H2 receptor antagonists (or H2 blockers) and proton pump inhibitors, which reduce the amount of acid produced by the stomach. Examples of H2 blockers are cimetidine, ranitidine, and famotidine; the drugs omeprazole and lansoprazole are proton pump inhibitors. If these medications do not work, surgery to remove damaged tissue or a section of the esophagus itself may be necessary.

Sometimes the damaged lining of the esophagus becomes thick and hardened, causing strictures, or narrowing of the esophagus. Strictures can interfere with eating and drinking by preventing food and liquid from reaching the stomach. Strictures are treated by dilation, in which an instrument gently stretches the strictures and expands the opening in the esophagus.

According to the National Institute of Health, about 5 to 10 percent of people with health issue develop cancer of the esophagus. Because of the cancer risk, people with are screened for esophageal cancer regularly.

Treatment

Currently, there are no medications to reverse this health issue. However, it appears that treating the underlying GERD may slow the progress of the disease and prevent complications. Here is a list of suggestions for reducing acid reflux:

1. Avoid eating anything within three hours before bedtime.

2. Avoid smoking and tobacco products.

3. Reduce consumption of fatty foods, milk, chocolate, mints, caffeine, carbonated drinks, citrus fruits and juices, tomato products, pepper seasoning, and alcohol (especially red wine).

4. Eat smaller meals. Avoid tight clothing or bending over after eating.

5. Elevate the head of the bed or mattress 6 to 8 inches. This helps to keep acid in the stomach. Pillows by themselves are not very helpful.

6. Lose weight if overweight. This may relieve upward pressure on the stomach.

Summary

Barretts Esophagus is a condition that may develop as a result of chronic GERD. Tissue growing in the esophagus appears to be the body's defense against continued stomach acid irritation. Yet, this tissue does not belong in the esophagus, and for some patients, it increases the risk of developing cancer. While treatment does not reverse the condition, the likelihood of developing cancer and complications may be reduced with a combination of diet, lifestyle changes, medication, and/or surgery. A regular program of endoscopic examination and biopsy is essential to monitor the Barrett's tissue. By working closely with a physician, patients can expect good control of both GERD and Barretts, and an excellent long-term outcome.