Barrett’s esophagus – causes, symptoms, treatment

Proven content

Barrett’s esophagus is a disease of the esophageal lining that often occurs as a complication of oesophageal reflux. Cells that normally line the esophagus from the inside (squamous epithelium) are transformed into cells that are not physiologically present in the lower esophagus (columnar epithelium). This ailment may result from chronic irritation of the root canal and lead to neoplastic disease.

Barrett’s esophagus – disease characteristics

Barrett’s esophagus is a condition that can even develop into cancer of the esophagus. The first symptom of the disease may be heartburn and an unpleasant burning sensation in the esophagus. Barrett’s esophagus is diagnosed when the natural boundary between the epithelia is destroyed and the squamous squamous epithelium is replaced by a cylindrical epithelium (esophageal tissue takes on the features of gastric tissue). About 20% of people suffer from chronic gastroesophageal reflux disease and esophagitis. Although the chance of cancer development is small, some patients develop dysplasia – the precancerous tissue. After Barrett’s esophagus is diagnosed, further testing for cancer is needed.

Causes of Barrett’s esophagus

Barrett’s esophagus is often the body’s response to acid reflux disease. It can manifest itself, among others:

1. heartburn,
2. vomiting
3. belching,
4. swallowing disorders.

It is likely that Barrett’s esophagus is more likely to appear in white men who have had esophageal reflux for a long time. Many patients have never had heartburn or acid reflux before, so it’s not entirely clear what causes Barrett’s esophagus.

Breakdown of Barrett’s esophagus

In our esophagus, there is a border between various cells (glandular and squamous epithelium) defined by the Z line. Depending on how long a fragment underwent metaplasia, we distinguish Baretto’s esophagus in the form:

1. short esophagus – lesions up to 3 cm long,
2. long esophagus – lesions are more than 3 cm long,
3. ultrashort esophagus – changes less than 1 cm (very difficult to diagnose).

We also divide Barrett’s esophagus into:

1. type I (circular) – concentric elevation of the Z line occurs around the entire circumference of the esophagus,
2. type II (lingual) – the Z line resembles irregular protrusions.

Symptoms of Barrett’s esophagus

Patients with Barrett’s esophagus often experience no symptoms, and if anything, these are considered symptoms of gastroesophageal reflux. Among them we distinguish:

1. pain in the chest,
2. dry cough,
3. frequent heartburn,
4. abdominal pain,
5. empty bouncing,
6. trouble swallowing
7. weight loss in a short time,
8. morning hoarseness
9. regurgitation of stomach contents into the esophagus,
10. upper gastrointestinal bleeding (may suggest cancer).

Other symptoms that go beyond reflux and indicate more serious conditions are:

1. bloody stool
2. bad luck chair,
3. vomiting blood.

The above symptoms are a must for consultation with a doctor.

Barrett’s esophagus – diagnosis

Barrett’s esophagus can only be diagnosed by a specialist who performs a gastroscopy. This examination reveals changes in the esophageal lining, but the final diagnosis requires a tissue biopsy (confirmation of changes in esophageal cells). Sections should be taken from each macroscopic lesion: visible ulceration, erosions, papules or strictures. Moreover, it is obligatory to take 2 cm sections from all 4 quadrants of the esophagus circumference.

The biopsy is also helpful in recognizing whether we are dealing with dysplastic cells and their degree of advancement. Cells with a higher degree are more likely to develop into neoplasms as opposed to cells with a lower degree of dysplasia.

After all the tests have been carried out, it is possible to implement appropriate treatment.

Treatment of Barrett’s esophagus

Treatment of Barrett’s esophagus depends on the extent to which the affected cells are dysplasia. If the patient has not developed dysplasia, treatment is limited to the usual control of esophageal reflux. Then the patient should change the lifestyle and take appropriate preparations. Sometimes surgery is required.

In the treatment of Barrett’s esophagus, proton pump inhibitors (omeprazole, pantoprazole, lansoprazole) are mainly used – they are the most effective because they inhibit gastric acid secretion the most; H2 blockers (reduce the production of hydrochloric acid in the stomach) and prokinetics. The latter are rarely used due to their lower effectiveness. If pharmacological treatment is ineffective, surgical excision of the esophagus is performed as a last resort. There are treatments that destroy the affected tissue (although they do not eliminate the risk of cancer). These are:

1. high temperature therapies – e.g. radio frequency ablation (uses electrodes mounted on a balloon or an endoscope that deliver heat energy to the diseased mucosa of the esophagus);
2. endoscopic surgery – e.g. resection of the mucosa, a method used when the mucosa is elevated or collapsed, which gives rise to the suspicion of cancer;
3. photodynamic therapy – using light and special chemicals (indicated only for the treatment of more severe conditions of Barrett’s esophagus). During endoscopy, laser light is applied to Barrett’s esophagus through a catheter inserted into the esophagus;
4. cryotherapy – spraying a very cold liquid or gas onto the diseased mucosa of the esophagus.

The above-mentioned treatments carry some risk and are not effective for every patient. A gastroenterologist specialist should analyze and select an appropriate method. The combination of drug therapy and endoscopic treatment makes it possible to completely or partially replace the cylindrical epithelium with normal squamous multilayer epithelium

Note: Pre-cancerous condition!

Barrett’s esophagus is a condition that can result in cancer of the esophagus. Systematic monitoring of inflammation and regular diagnostic tests are very important. The doctor will individually arrange the control tests for dysplasia diagnosis.