Barrett's Esophagus
Sutter Davis Hospital Gastroenterology

Definition
Barrett esophagus (BE) is also called columnar-lined esophagus. The esophagus is the tube that carries food and liquid from the throat to the stomach. Barrett esophagus is a type of precancerous disease that affects and damages the esophagus. Precancerous means that it may lead to cancer (tumor). Normally, cells reproduce by splitting in a planned way, making more cells only when needed. With Barrett esophagus, normal cells lining the esophagus may have had an injury that caused inflammation (swelling) and damage. When the damaged areas heal, abnormal cells grow and divide without order, and replace the normal cells. This process may later lead to esophagus cancer.
Causes
The exact cause of Barrett esophagus is not known. Caregivers believe that Barrett esophagus is related to long-standing gastroesophageal reflux disease (GERD). GERD occurs when you have a weak lower esophageal sphincter. A sphincter is a ring-like muscle that opens and closes an opening in your body. If the sphincter relaxes too often, it causes stomach acid to reflux (back up) into the esophagus. This acid irritates and damages the esophagus, which may later lead to abnormal changes in the cells lining the esophagus. The following are other possible conditions and factors that may increase your risk of having Barrett esophagus:

• Age: The incidence of Barrett esophagus increases with age. Men above 40 years of age are usually affected.
• Family history: Having a close family member with GERD, Barrett esophagus, or esophageal cancer.
• Obesity: Weighing more than what your caregiver suggests may put pressure on your stomach. This pressure causes stomach acid to reflux into the esophagus.
• Unhealthy lifestyle: Some caregivers think that smoking cigarettes and drinking alcohol may also cause Barrett esophagus.

Symptoms
Signs and symptoms of Barrett esophagus are usually related to GERD signs and symptoms. Heartburn, the most common symptom of GERD, may also be present in Barrett esophagus. It is a feeling of burning pain in your chest or below the sternum (chest bone). This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have any of the following:

• Bitter or acid taste in your mouth
• Choking, coughing, or shortness of breath
• Frequent burping or hiccups
• Pain or trouble while swallowing
• Vomiting (throwing up) blood or having black, tarry stools
• Weight loss

Treatment
Treatment for Barrett esophagus depends on its grade. It includes controlling your symptoms and preventing esophageal cancer. Your caregiver may suggest that you make diet and lifestyle changes, such as losing weight. You may also need any of the following:

• Medicines: Medicines may be given to relieve the symptoms caused by Barrett esophagus. Anti-reflux medicines help decrease the stomach acid that can irritate your esophagus and stomach. These medicines may include proton pump inhibitors (PPI) and histamine type-2 receptor (H2) blockers. You may also be given medicines to stop vomiting.
• Surgery: Surgery may be done when your medicines cannot control your symptoms or other problems, such as high-grade dysplasia, are present. Your caregiver may also suggest surgery depending on the type of Barrett esophagus that you have. Surgeries may include the following:
• Fundoplication: Fundoplication is a surgery that wraps the upper part of the stomach around the esophageal sphincter to strengthen it. Strengthening the sphincter may help to prevent reflux. Ask your caregiver for more information about fundoplication.
• Resection or esophagectomy: Your caregiver may remove a part of or the entire esophagus.
  
• Other treatments: Ask your caregiver about the following treatment options for Barrett esophagus.
• Ablation: Barrett esophagus may be treated by using a special thermal (heat) ultrasound or freezing ablation treatment.
• Photodynamic therapy: Lasers, in combination with medicines that become active when exposed to light, are used to destroy abnormal cells.

Where can I find support and more information?
National Digestive Diseases Information Clearinghouse (NDDIC)
2 Information Way
Bethesda, MD20892-3570
Phone: 1-800-8915389
www.digestive.niddk.nih.gov