Barretts Escophagus |
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The name may not be familiar to you, but thousands of Americans are diagnosed each year with Barrett's esophagus, a precancerous condition often associated with severe heartburn. If you have been told you have Barrett's Esophagus, this brochure may help answer some of your questions. If you have additional questions, ask your doctor.
What Is Barrett's Esophagus?
To help you digest your food, your stomach produces large amounts of hydrochloric acid every day. This powerful acid can liquefy a piece of meat in a short time, but amazingly does not damage your stomach itself. This is because your stomach has a special lining to protect itself from the effects of the acid. However, your esophagus, or food pipe, has no protective lining. Instead, there is a one-way valve located at the bottom of the esophagus that normally prevents backflow of stomach acid.
Called the Lower Esophageal Sphincter, this valve opens to allow food to enter the stomach and then quickly closes to prevent the corrosive stomach acid from damaging your delicate esophageal lining. If this valve gets weak, however, acid from the stomach is allowed to come up into the esophagus causing red erosions, like scrapes of the skin, on the normally pinkish lining of the esophagus. If the erosions continue, a new red lining, which resembles that of the stomach, will develop. This is termed Barrett's Esophagus - named after British surgeon, Norman Barrett, who first identified this ailment in 1950. So, Barrett's is a condition where the pink lining of the lower esophagus is damaged by months or years of uncontrolled heartburn and then the damaged area is replaced by red stomach lining which creeps up into the lower esophagus. About 10% of patients with severe heartburn, mostly men, will go on to develop changes of Barrett's Esophagus. |
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| Why Is Barrett's Important? |
| Patients with Barrett's Esophagus are 40 times more likely to develop esophageal adenocarcinoma: one of the fastest growing, and most lethal, cancers in the United States. Considered an oddity until the 1970s, the cancer has increased rapidly in the past two decades and now accounts for more than half of all esophageal cancers. |
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| What Are The Symptoms? |
| There really are no symptoms of Barrett's itself, but most patients have a history of long-standing acid reflux and complain of heartburn or indigestion, occurring daily or very regularly. Other symptoms may include: difficulty swallowing food, waking up at night because of heartburn pains, persistent unexplained cough, or vomiting. If you have these symptoms, you should be checked for Barrett's. Unfortunately, some patients with Barrett's have very little heartburn and no warning, even though they have significant damage. |
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| How Does My Doctor Know? |
| Barrett's cannot be diagnosed by any blood tests or an x-ray. Screening for Barrett's esophagus requires an endoscopic, or scope, evaluation to directly visualize the lower esophagus and determine if there is any damage. This is painlessly done under light sedation. During this exam, samples can also be taken to check for precancerous changes, or dysplasia. |
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| Why Bother Checking For Barrett's? |
| The challenge is to identify patients with Barrett's esophagus before they develop cancer. If you have Barrett's and biopsies show precancerous cells, new techniques are available to halt the process. Progression to cancer can often be prevented. But, it's estimated that only 5 percent of people with Barrett's are now diagnosed. |
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| What Treatment Is Available? |
Once Barrett's esophagus is identified, doctors have several treatment options available. The first goal is to stop acid reflux and prevent further damage from occurring. This can usually be accomplished with daily doses of medications such as Prilosec and Prevacid which markedly reduce your production of stomach acid. In some cases, other medications may also be prescribed such as Propulsid which tightens the lower esophageal sphincter and hastens stomach emptying - further reducing acid reflux. Treatment aids in the relief of symptoms and may also reduce the risk of forming a stricture, or ring of scar tissue, which is common in Barrett's and may cause problems swallowing.
You should know that successful treatment of the acid reflux does not cure the Barrett's. Even if symptoms are well controlled, the cancer risk remains and periodic scope examinations must be continued. Usually these are done every one to two years. |
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| What If Dysplasia Is Found? |
Biopsies taken during the scope test are sent for microscopic analysis by a trained doctor called a pathologist. The main thing we ask the pathologist to look for are changes of dysplasia. Dysplasia is a precancerous change which usually occurs before cancer ever develops. It can be thought of as an early warning signal and is often classified as low grade, moderate, or severe dysplasia .
Low grade dysplasia is seen most often and is less cause for concern. In this instance, reflux must be controlled and surveillance may need to be more frequent but there is no need for radical change in therapy. Over time, dysplasia may progress from low grade, to moderate, to high grade, then sometimes to cancer.
If moderate or severe dysplasia is found, you will need to be rescoped at more frequent intervals and additional biopsies obtained. If severe dysplasia persists, there is a high risk of progression to cancer. In this circumstance, more aggressive treatment is needed. This might involve surgery to remove the abnormal area of Barrett's, even if a definite cancer is not found. The whole idea is to do something before cancer develops. |
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| How About Surgery? |
There are two types of surgery performed in cases of Barrett's. If no dysplasia is present and symptoms of acid reflux do not respond to intensive medical therapy, surgery may be necessary to retighten the loosened lower esophageal sphincter, thus preventing further acid damage. This operation does not remove the area of Barrett's which still must be periodically rebiopsied annually. In the past, this procedure required open surgery with a full incision and prolonged recovery period. Newer bandaid techniques now allow a much simpler procedure with several mini-incisions and a shortened recovery period.
If the condition is identified at a later stage, patients may require surgery to actually remove the lower part of the esophagus and pull the stomach upward to the remaining portion. This is a more radical operation, but totally removes the area of Barrett's. |
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| Are There Any Alternatives? |
| Recently, a new technique has been studied called PDT, or photodynamic therapy. In this procedure, special light-activated dyes are given by vein which make the area of Barrett's especially sensitive to laser light. This allows selective destruction of the area of Barrett's lining without damaging the entire wall of the esophagus. The area becomes ulcerated and is treated with medication. In most cases, when the ulcer heals, it is replaced by the normal pale esophagus lining and not the abnormal stomach lining. |
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| Summary |
Barrett's esophagus is a precancerous condition in which stomach lining grows up into the lower esophagus. This is usually a consequence of long-standing poorly controlled heartburn. Barrett's tissue does not belong there and for some reason increases the risk of cancer. Most often, the development of this type of cancer is preceeded by findings of dysplasia on biopsy.
If you have Barrett's Esophagus, you will require periodic monitoring by your physician. Follow your doctor's advice about how best to control your acid reflux. This may include lifestyle changes, medication, and/or surgery. The goal should be complete control of heartburn. Keep your appointments for regular endoscopy exams and biopsies to check for dysplasia
Be reassured that most patients with Barrett's do not go on to develop cancer of the esophagus. By working with your doctor and having periodic examinations, you can best control the symptoms of reflux and reduce your personal risk of cancer of the esophagus. |
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