Barrett’s esophagus

Barrett's esophagus is a disorder in which the lining of the esophagus (the tube that carries food from the throat to the stomach) is damaged. The damage is caused by stomach acid that leaks back into the esophagus. This leakage of acid is commonly known as "heartburn" (gastroesophageal reflux).

Irritation of the lining of the esophagus by stomach acid causes Barrett's esophagus. It happens more frequently in men than women. Risk factors are frequent and long-standing gastroesophageal reflux. The condition carries an increased risk of cancer of the esophagus.

Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus results in symptoms of heartburn. Rarely, Barrett's esophagus can progress to cancer of the esophagus, the symptoms of which may be difficulty swallowing or weight loss.

Looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination (esophagoscopy with biopsy) may reveal Barrett's esophagus. A barium x-ray will not show the flat changes of Barrett's esophagus.

Treatment includes general measures to control gastroesophageal reflux, medications, photodynamic therapy (PDT), and surgery. Treatment may be important even if the patient doesn't feel any symptoms.

General measures include:

• Weight reduction
• Avoiding lying down after meals
• Sleeping with the head of the bed elevated
• Taking medication with plenty of water
• Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure
• Avoiding alcohol and tobacco

Medications to relieve symptoms and control gastroesophageal reflux include antacids after meals and at bedtime, histamine H2 receptor blockers, proton pump inhibitors, cholinergic agents, and promotility agents.

Surgery to remove a portion of the esophagus may be recommended, if a biopsy shows the type of cellular changes that tend to lead to cancer (these changes are called dysplasia).

Photodynamic therapy (PDT) is a newly approved option that may allow you to avoid surgery. PDT involves the use of a special laser device, called an esophageal balloon, along with a drug called Photofrin. Together, the laser balloon and medication lead to destruction of the abnormal cells lining the esophagus, without affecting the normal tissue.

An increased risk of esophageal cancer is present. Follow-up endoscopy to look for dysplasia or cancer is often advised.

• Esophageal dysplasia
• Esophageal cancer

Call your health care provider if heartburn persists for longer than a few days, or you have pain or difficulty swallowing.

Call your provider if symptoms worsen, do not improve with treatment, or if new symptoms develop in a person with Barrett's esophagus.

Diagnosis and treatment of gastroesophageal reflux may prevent Barrett's esophagus.