What is Barrett's Esophagus?

Barrett's esophagus is a condition in which the flat, squamous cells lining the esophagus (food pipe) are replaced by columnar shaped cells resembling those present in the lining of the intestines. This change in the cellular lining is called metaplasia and is not usually associated with any signs or symptoms.

The Healthy Esophagus

The esophagus contains two sphincters or muscular gates at either end. When a person swallows, the upper sphincter relaxes to allow food or drink to pass from the mouth into the esophagus and the lower sphincter opens to let food into the stomach. The lower esophageal sphincter then rapidly closes to prevent the food or drink from leaking out of the stomach and back into the esophagus and mouth.

Risk Factors for Barrett's Esophagus

Barrett's esophagus is most commonly found in people with gastroesophageal reflux disease (GERD).

Also called acid reflux disease, GERD occurs when the lower esophageal sphincter opens at inappropriate times or does not close properly, allowing the contents of the stomach to seep back into the esophagus. If GERD is left untreated, it can eventually lead to complications such as ulcer, scarring, narrowing of the esophagus or Barrett's esophagus.

Although people who do not have GERD can develop Barrett's esophagus, the condition is found about three to five times more often in people who have GERD.

Other risk factors include:

• Age: Barret's esophagus is commonly diagnosed in middle-aged and older adults, with an average age-at-diagnosis of 50 to 55 years. Barrett's esophagus is uncommon in children.
• Male gender: Men are twice as likely as women to develop Barrett's esophagus.
• Lifestyle: Smokers are more frequently diagnosed with Barrett's esophagus than nonsmokers.

Outcome

Barrett's esophagus may occasionally give rise to esophageal cancer. Less than one percent of people with Barrett's esophagus develop cancer but of those who do, Barrett's esophagus may well have been present for several years.

Barrett's esophagus affects about one percent of adults in the United States.

Diagnosis

Detection of the condition is difficult as there may be few or even no symptoms. Physicians recommend that adults older than 40 who have had GERD for a number of years undergo a screening procedure called upper gastrointestinal endoscopy to test for the disease.

The procedure involves inserting a thin flexible tube with a light and camera into the esophagus to view the inner lining. Surgical instruments can be slid through the tube to remove a small piece of tissues if a site appears to be affected, a process called biopsy.

The tissue is then sliced into thin, microscopic sections, fixed onto a glass slide and stained with appropriate dyes. The slide is then examined under the microscope and checked for any alteration in cellular pattern.

Treatment

Treatment of Barrett's esophagus may be endoscopic or surgical.

The endoscopic therapies available include destroying the altered wall lining using ablation techniques such as laser beam therapy or cryotherapy. The goal of the treatment is to encourage normal esophageal tissue to replace the damaged and destroyed areas.

Surgical therapy involves removal of the affected segments of the esophagus. Those with severe cellular changes may require complete removal of the esophagus.