Barrett's Esophagus

Barrett's esophagus is a complication of esophageal inflammation that is caused by the so-called gastroesophageal reflux disease (also inaccurately referred to as heartburn, which is actually just a symptom of reflux disease). Gastroesophageal reflux disease means a return of stomach acid back into the esophagus due to inadequate function of the lower esophageal sphincter.

Causes

A continuous exposure to aggressive gastric fluid containing hydrochloric acid has harmful effect on esophageal mucosa. Mucous membrane irritation is followed by a chronic inflammation. As a defensive (but undesirable) reaction the mucosa may change over time. To be more exact it turns into a mucosa histologically similar to intestinal mucosa. It is probably due to fact that this kind of mucosa is more resistant to gastric juices. These changes are referred to as sites of Barrett's esophagus. They are usually located in the lower part of the esophagus near the so called gastroesophageal junction (border between esophagus and stomach). The most interesting and disturbing fact Barrett's esophagus is a form pro precancerous lesion, i.e. there is a slight possibility of altered epithelium transformation into esophageal cancer.

Symptoms

Barrett's esophagus is only a histological term and has no obvious symptoms. Its presence can however be accompanied by typical symptoms of gastroesophageal reflux disease like heartburn and difficult swallowing. Very often Barrett’s esophagus is randomly found during upper GI endoscopy by a totally asymptomatic person.

Diagnosis

The best diagnostic method is endoscopy, i.e. esophagogastroduodenoscopy. Barrett's esophagus is visible as an area of velvety red mucous membrane in distant esophagus. A better view can be achieved by using chromoendoscopic methods. Definitive diagnosis is merely histological so it is necessary to take a biopsy sample from the suspiciously looking mucosa.

Treatment

The treatment should be primarily focused on therapy of gastroesophageal reflux disease, i.e. mainly using drugs lowering gastric acidity, especially the proton pump inhibitors. It must be emphasized, however, that once accomplished mucosal changes are irreversible and all patients with existing Barrett’s esophagus should be regularly monitored by upper endoscopies to prevent a tumor occurrence.

 

If there is a high risk of esophageal cancer formation (estimated from histology) a surgical intervention is needed – usually a resection of affected section of esophagus.