Barrett's Esophagus

Barrett’s esophagus is a condition that is caused by reflux which causes inflammation of the esophagus. It is named after Norman Rupert Barrett, a British surgeon who noticed discoloration of the lower esophagus in patients undergoing surgery for acid reflux. This condition occurs when the squamous cells of the esophagus are replaced by columnar cells (this process is called metaplasia) which are usually found in the intestinal lining. The main cause of Barretts is gastroesophageal reflux disease, also known as GERD, a condition where stomach acid flows back into the esophagus. Barretts is more commonly seen in the Caucasian race, males, and patients with hiatal hernias. The mean age is around 60 and it is rare in children.

Symptoms of Barrett’s esophagus include heartburn, difficulty swallowing and acid reflux. Severe cases include chest pain, vomiting red blood or passing tarry stool and these symptoms should prompt immediate medical attention. Factors that increase your risk of Barrett’s include family history, chronic heartburn and acid reflux, smoking, and obesity.

Studies have shown that people with Barrett’s have an increased risk of lower esophageal cancer which is amongst the fastest growing types of cancer. The risk of developing cancer increases with duration of the disease and with length of Barretts segment seen on endoscopy. Hence, patients with signs and symptoms for a longer duration are at higher risk for developing esophageal cancer. It is highly important to get tested if you experience symptoms of reflux. The diagnosis for Barrett’s is done through an upper endoscopy procedure which can be performed locally in Westchester and Putnam counties.

Barrett’s esophagus treatment options vary based on the severity of the condition and the presence of symptoms. For most patients, lifestyle changes such as weight loss, dietary modifications, and smoking cessation are key components of management. These steps can help reduce acid reflux and prevent further damage to the esophageal lining.

One of the primary pharmacological treatments involves proton pump inhibitors (PPIs), which reduce stomach acid production, helping to control acid reflux and lower the risk of further damage. Some studies have shown that low-dose aspirin can help prevent the progression of Barrett's esophagus. Sucralfate is another option; it forms a protective coating over the esophageal lining, shielding it from stomach acid and promoting healing.

For patients with Barrett's esophagus, regular surveillance endoscopies are crucial to monitor for any signs of precancerous changes, also known as dysplasia. If these changes are detected, then appropriate interventions may be necessary.

Treatment options for dysplasia may include:

• Radiofrequency ablation (RFA): This minimally invasive procedure is used to destroy the abnormal tissue, promoting the regrowth of healthy squamous cells in the esophagus.
• Endoscopic mucosal resection (EMR): This procedure is an alternative and involves removing precancerous tissue using a snare device.
• Esophagectomy: In severe cases, partial or total removal of the esophagus may be required. This is typically reserved for patients with high-grade dysplasia or esophageal cancer.

Each treatment plan should be tailored to the individual patient, and close monitoring is essential to manage the condition and prevent complications.

For further information, you can make an appointment with your local physicians or on the Westchester Putnam Gastro Website

Sincerely,

Sunil Gupta MD, Anushka Manohar MA

Citation for image: Hudson Valley Gastroenterology | NewYork-Presbyterian Medical Group Hudson Valley