The esophagus is a tube which carries food and liquids from the mouth into the stomach as part of the digestion process. The stomach slowly pumps these substances into the intestine which goes on to absorb the necessary nutrients. The muscular layers of the esophagus are typically pinched together at both the upper and lower ends by muscles known as sphincters. When you swallow, these sphincters relax to allow food and drink to pass from mouth to stomach. These muscles then close rapidly in order to prevent food and drink from leaking out from the stomach and back up into the esophagus and mouth.
Barrett’s esophagus is a condition in which the tissue lining the esophagus is replaced by tissue similar to that found in the lining of the intestine. This occurs through a process called intestinal metaplasia.
The condition has no outward signs or symptoms but is commonly found in people who already have advanced acid reflux or gastroesophageal reflux disease (GERD). GERD is the presence of persistent acid reflux, more specifically in individuals experiencing acid reflux symptoms more than twice in a week. Ten to twenty percent of Americans experience GERD symptoms daily, making it one of the most common medical conditions affecting people of all ages.
A small minority of individuals who develop Barrett’s esophagus develop a rare but often deadly cancer of the esophagus. Barrett’s esophagus affects about one percent of adults in the United States. The average age of diagnosis is 50 years, however, initial discovery of the condition may be difficult. Men develop the condition twice as often as women. The disease is uncommon in children and youth.
Getting help for Barrett’s and for the treatment of advanced acid reflux (GERD) which can lead to Barrett’s, is essential as it can prevent further complications and conditions from arising. An individual can have Barrett’s for several years before it develops into esophageal adenocarcinoma or esophagus cancer. Typically, before this cancer develops, precancerous cells appear in the Barrett’s tissue which builds up in the damaged esophagus. This is known as dysplasia and can be seen only through biopsies. If you have lived with severe acid reflux (GERD) symptoms for many years, see your doctor and ask about the possibility of undergoing a biopsy of the esophagus to determine your Barrett’s and cancer risk.
If you have Barrett’s, you may wish to be pro-active against the condition and fight acid reflux symptoms while discussing endoscopic and surgical treatment plans with your doctor. Stay away from spicy, acidic or fatty foods as these are most likely to cause acid reflux reactions.
Acid reflux and its symptoms, especially in increased severity, can be a burden and constantly painful during times of ingestion. Consult with your doctor to find the best over-the-counter medication for you and work out a treatment plan that utilizes all of your options.
What causes the stomach acid to come back up into the esophagus during acid reflux?
- Basic acid reflux or GER occurs when the stomach contents reflux or back up into the esophagus during or following the ingestion of a meal. At the bottom of the esophagus there is a ring of muscle called the lower esophageal sphincter (LES) which opens and closes allowing food to enter the stomach. Typically, the LES opens after meals to releases gases. Sometimes when the LES opens the stomach contents, including digestive juices or acids, reflux back up into the esophagus. This can lead to a burning sensation or in the case of babies and infants, spitting up or vomiting.
How do I know if my acid reflux has progressed to GERD or advanced acid reflux?
- Acid reflux is a much more mild condition, usually entailing frequent heartburn or the bitter burning sensation in the chest and back of throat as acid rises from the stomach. GERD is a more serious condition which occurs in severity more than twice weekly. Patients may also experience a dry couch, asthma like symptoms or trouble swallowing. If you are experiencing these symptoms or are having reflux episodes two to three times a day you should consult your doctor about the possibility of having GERD.
The exact cause of Barrett’s esophagus is not fully known but it is understood that having GERD is a risk factor for developing the condition. Although people who do not have GERD can have Barrett’s, the condition is found about three to five times more often in people who also have GERD.
Obesity, pregnancy and habitual traits such as regular smoking, can all actively contribute to acid reflux. However, it is still generally unknown why acid rises into the esophagus for some individuals more than others. Certain habits and environmental traits can worsen the condition. Fatty, spicy and acidic foods most commonly set up acid reflux reactions. Frequent ingestion of worsening agents can transition normal and regulated acid reflux to GERD which is an advanced stage of the gastrointestinal condition. About 5 percent of the 20 million Americans with acid reflux, have significant episodes 2 or 3 times a day. This signifies GERD and if you experience symptoms in this form of regularity, you should seek medical attention to prevent the development of Barrett’s.
Living with Barrett’s can go unnoticed as the condition does not present symptoms that differ from advanced acid reflux (GERD). If you have accustomed yourself to living with these severe symptoms, you may not fully realize when the condition has complicated itself to a point of becoming Barrett’s. If you regularly suffer from intense acid reflux symptoms, speak with your doctor about the possibility of further testing.
Even before consulting with your doctor, you may wish to try avoiding certain foods and reaction agents as well as incorporating over-the-counter medication to see if your acid reflux improves. Speak with a pharmacist to know the full range of options you have. Make sure to mention how often you encounter symptoms as well as their severity. Try not eating out as you cannot monitor what goes into your food. Avoid smoking and alcohol as well as fatty, spicy and acidic foods.
When consulting your physician about treatment, ask how to prevent acid reflux from returning following Barrett’s surgery. Learn pro-active and preventative measures you can take to lower your cancer risk and ease your post-ingestion pain.
Because Barrett’s esophagus is a complication of GERD, it does not have different or new symptoms besides those present in the GERD condition. GERD is an advanced form of acid reflux. Acid reflux occurs when the lower esophageal sphincter muscle opens up spontaneously for varying periods of time or simply does not close properly thereby allowing stomach acid and contents to rise up into the esophagus. This condition is also known as acid regurgitation because digestive juices or the acid present in the stomach cavity, rise with the food.
Symptoms of acid reflux include feeling food or fluid in the back of the mouth as well as the sensation of tasting it. Once stomach acid touches the lining of the esophagus, a burning sensation may be felt in the chest or throat which we call heartburn or indigestion. GERD is acid reflux which occurs more than twice weekly. If you experience persistent acid reflux symptoms, see your doctor to avoid developing a complication such as Barrett’s esophagus.
Diagnosis of Barrett’s esophagus primarily depends on the individual experiencing advanced and frequent acid reflux symtpoms and their decision to seek medical treatment. Because Barrett’s esophagus produces no new symptoms, many physicians recommend adults older than age 40 who have had GERD for many years, undergo an endoscopy and biopsies to check for the development of Barrett’s esophagus.
An upper gastrointestinal endoscopy can be used to obtain biopsies of the esophagus to check for the condition. After the patient has been sedated, the doctor inserts a flexible tube, known as an endoscope, into the esophagus. This tube has a light and miniature camera to allow the doctor a closer look at the internal tissue. If the tissue appears suspicious, the doctor proceeds to remove several small pieces using a pincher-like device which is passed through the endoscope. The tissue undergoes testing to reach a proper diagnosis.
Barrett’s esophagus is more commonly seen in individuals suffering from advanced acid reflux or GERD so physicians recommend treating GERD symptoms with acid-reducing drugs. This treatment plan may lower the risk of developing Barrett’s esophagus.
GERD symptoms can be treated by over-the-counter, acid-reducing medication called antacids as well as anti-secretory drugs like H2 blockers and proton pump inhibitors. Examples of possible treatment medications include:
- Alka-Seltzer
- Maalox
- Mylanta
- Pepto-Bismol
- Riopan
- Rolaids
- Cimetidine (Tagamet HB)
- Famotidine (Pepcid AC)
- Nizatidine (Axid AR)
- Ranitidine (Zantac 75)
- Esomeprazole (Nexium)
- Iansoprazole (Prevacid)
- Omeprazole (Prilosec, Zegerid)
- Pantoprazole (Protonix)
- Rabeprazole (Aciphex)
Individuals with Barrett’s esophagus have a low but present risk of developing cancer known as esophageal adenocarcinoma, a cancer affecting the esophagus. However, less than one percent of people with Barrett’s esophagus develop this cancer each year. Typically, before cancer develops, precancerous cells appear in the Barrett’s tissue within the esophagus. This condition is called dysplasia and can be detected only through the use of biopsies.
Surgical treatments are available to treat severe dysplasia and cancer which come as a result of Barrett’s esophagus. During these therapies, the Barrett’s lining is destroyed or the portion of infected tissue is cut out. The goal of this particular treatment procedure is the encouragement of normal esophageal tissue to replace the destroyed Barrett’s lining. Following the removal of a portion of the esophagus, a portion of the stomach is sometimes used and pulled up into the chest and attaching to what remains of the damaged esophagus.
There are endoscopic procedures available as well which can be performed at specialty centers by physicians. Photodynamic Therapy (PDT) and Endoscopic Mucosal Resection (EMR) can be used in the treatment of severe Barrett’s esophagus. PDT uses a light-sensitizing agent and a laser to kill precancerous and cancerous cells. The agent is injected into a vein and the patient returns 48 hours later for the procedure. The laser light is passed through the endoscope and activities the agent to destroy Barrett’s infected tissue in the esophagus. EMR involves lifting the Barrett’s lining and injecting a solution under it or using suction and cutting off the damaged tissue. The lining is then removed through the endoscope.