By Asif M. Qadri, MD
Barrett’s esophagus (BE) is what results for chronic, untreated gastroesophageal reflux disease whereby normal squamous lining of the distal esophagus is replaced by columnar, epithelium-containing specialized intestinal metaplasia. To put it simply this, normal cells are flat-shaped (aka squamous cells) whereas Barrett’s cells are shaped like columns. Those affected with disease process develop a higher risk for esophageal cancer. There are an estimated 200,000 cases per year in the U.S. The condition is named after the Australian-born British thoracic surgeon Norman Barrett, who described the condition in 1950.
The exact cause of this condition is unknown but commonly found in those individuals who have a history of gastroesophageal reflux disease or GERD. GERD is a condition whereby acids within the stomach come in contact with tissue lining the esophagus. Given the repeated exposure to stomach acid, the esophageal tissue becomes damaged but eventually will heal and may transform into this new type of cell known as “metaplasia.” Other symptoms associated with Barrett’s esophagus include heartburn, chest pain, nausea, vomiting, shortness of breath, wheezing, difficulty or painful swallowing.
It is estimated that as much as seven percent of the U.S. population suffers from this condition, and usually the condition is diagnosed after the age of 55. Those with this diagnosis require routine endoscopic evaluation with biopsies for surveillance of any changes to precancerous cells. Men are twice as likely to develop this compared to women. Those who have hiatal hernias are also more likely to suffer from chronic GERD, and thus increase their risk for developing Barrett’s. It is a premalignant phase which may result in cancer of the esophagus if it is not treated.
Once diagnosed, endoscopic surveillance of patients with Barrett’s permits detection of cell changes (dysplasia or carcinoma) at an early stage and improves long-term survival after resection for severe dysplasia and invasive carcinoma. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as localized invasive cancer that has not spread beyond the esophagus.
Treatments include first line treatments which have included the daily use of H2 Blockers (such as Zantac, Pepcid, Tagamet) or Proton Pump Inhibitors aka PPI’s (such as Nexium, Dexilant, Prilosec and Protonix). Medical procedures used to help treat include the above mentioned surveillance EGD. However, if there is evidence of high grade dysplasia or cancer, there are many options prior to the ultimate treatment of Esophagectomy which is the surgical removal of all or part of the esophagus. Other common treatments prior to surgery include endoscopic mucosal resection (EMR), photodynamic therapy (PDT), argon plasma coagulation (APC), electrocoagulation, and even possibly an esophageal stent. These procedures are usually performed at a high level tertiary center (Cleveland Clinic, Mayo Clinic, Emory, etc.) by a skilled endoscopist trained in the treatment modalities listed. Gastroenterologist will work in conjunction with oncology to optimize the treatment and curative success of each individual patient.
I encourage you to discuss and esophageal discomforts or symptoms with your doctor. We would love to see you at Athens Digestive Healthcare Associates, recently voted the number two GI practice in Georgia by “Healthgrades,” whereby we can help correct the problem and ensure the prevention of further esophageal damage.
Dr. Qadri attended the School of Medicine at American University of the Caribbean. He is Board Certified in Internal Medicine and specializes in Gastroenterology, Hepatology, and Internal Medicine. He is part of Athens Digestive Healthcare Associates: 1500 Oglethorpe Ave # 500. Athens, GA 30606. For more information and to schedule an appointment, please call (706) 850-4985.