What is Barrett’s esophagus?
Barrett’s esophagus (or simply Barrett’s) is a pre-cancerous condition that increases the risk of esophageal cancer (EC) when compared to other patients with GERD. These two esophagus problems are the most serious of all GERD complications. If you have been diagnosed with Barrett’s esophagus, the cells in your esophagus have changed, indicating that you have an increased risk of esophageal cancer, and you should be in active “surveillance mode.” The management and treatment of this condition is controversial. It is imperative that you have an understanding of Barrett’s so that you can take control of your disease and help select the management program that is best for you.
In patients with Barrett’s, GERD symptoms can be highly variable. Barrett’s, along with EC, are two serious esophagus conditions are a direct result of significant, longstanding reflux and symptoms are usually severe. However, in some cases, they may actually be quite minimal, particularly for those using acid suppressive medications.
RefluxMD believes that patients with Barrett’s esophagus require expert management. RefluxMD’s medical advisors have identified a small group of GERD physicians who meet the highest standard and follow the Pasadena Protocol. We term these physicians Refluxologists. They are experts in the management, diagnosis, and treatment of GERD, including Barrett’s esophagus and its treatment strategies and options. You can begin your search for one of these specialists using our Find a Physician directory.
Barrett’s esophagus: What does it mean to you?
With the diagnosis of Barrett’s esophagus, EC risk becomes very important along with symptom control. This represents a significant change in focus from the other three stages of GERD. Esophageal cancer must be avoided.
Fortunately, Barrett’s should not be feared, but it must be managed correctly. In actuality, the likelihood of developing cancer is small. You have up to a .5% chance per year of developing cancer, which translates to a 10% risk over 20 years.
It is essential that those individuals with Barrett’s esophagus undergo endoscopy every 1 to 3 years in order to reevaluate the extent of disease. Biopsies are taken which will determine whether your condition is “stable” or if it has progressed to a condition called dysplasia, indicating an undesirable cellular change. Dysplasia carries with it a higher risk of cancer when compared to Barrett’s.
Barrett’s esophagus: Management strategies and treatment options
As discussed earlier, the management of Barrett’s is controversial. There are three treatment strategies available:
- Medical management, primarily with PPIs;
- Surgical procedures which restore the barrier to reflux, and;
- “Ablative” procedures that “burn away” the Barrett’s tissue. Ablation is combined with either surgery or PPI therapy.
The implementation of any of these therapies does not change the need for periodic surveillance endoscopies as discussed previously.
Acid suppressive PPIs control symptoms, but do not prevent or even reduce the reflux. The chemicals (carcinogens) in stomach juice that are responsible for the progression of Barrett’s to cancer continue to bathe the lining of the esophagus, including the area of Barrett’s tissue. To date, RefluxMD has found no credible evidence that acid suppressive drug therapy prevents the progression of Barrett’s to dysplasia and ultimately esophageal cancer. In addition, PPI therapy also has effects that, conceivably, might promote the development of cancer in Barrett’s esophagus.
The surgical approach reconstructs the dysfunctional LES, improving its barrier function to reflux. This actually stops the reflux which prevents the carcinogen in the stomach contents from reaching the lining of the esophagus. With a successful anti-reflux procedure, there is likelihood that cancer can be prevented. Also, the symptoms caused by reflux are resolved, eliminating the need for acid suppressive medications, including PPIs. As with any surgical procedure there are risks and side effects that must be balanced with the potential benefits. RefluxMD stresses that by understanding these aspects of anti-reflux surgical procedures, an informed choice of therapy can be made.
Ablation means directly burning away the lining of the esophagus involved with Barrett’s tissue. This is usually used for tissue that has progressed beyond Barrett’s to dysplasia. After the affected area is treated, the esophageal lining grows back to its original normal state in hopes of decreasing or eliminating cancer risk. However, ablation does not stop the reflux and GERD symptoms continue, requiring continued PPI therapy or an anti-reflux surgical procedure.
Understand your choices with serious esophagus problems
Although seemingly complex, you should fully understand all of these options and strategies for the management of Barrett’s esophagus and esophageal cancer. RefluxMD offers many resources to answer your questions and assist you with your decisions. Take control of your disease. The final choices and decisions must be made by you.
Reviewed by: Dr. Dengler, RefluxMD Medical Director