Barrett’s esophagus involves a cellular transformation in the lining of the swallowing tube connecting the mouth to the stomach. While abnormal cells can be addressed, the underlying predisposition often persists, making long-term management crucial.
What is Barrett’s Esophagus
Barrett’s esophagus is an abnormal change in the cells lining the lower esophagus. Normally, this lining has flat, pink squamous cells. In Barrett’s, these are replaced by columnar cells resembling those in the intestine, a process called intestinal metaplasia. This alteration often results from chronic irritation by stomach acid and bile, linked to long-standing gastroesophageal reflux disease (GERD).
These intestinal-like cells, including goblet cells, are considered precancerous. Though not cancer, they increase the risk of developing dysplasia, where cells appear more abnormal, and, less commonly, esophageal adenocarcinoma. Dysplasia is classified as low-grade or high-grade based on microscopic appearance, with high-grade indicating a greater likelihood of cancer progression. Diagnosis involves an upper endoscopy, where a doctor visually inspects the esophageal lining and takes biopsies for examination.
Can Barrett’s Esophagus Be Cured
While abnormal Barrett’s cells can be removed or destroyed, the underlying susceptibility to developing them from chronic acid reflux is not eliminated. Treatment aims to remove altered tissue and reduce cancer progression risk, often through endoscopic procedures to eradicate abnormal cells.
Radiofrequency ablation (RFA) is an endoscopic procedure using heat to destroy precancerous cells. An electrode delivers heat to the lining, causing tissue to slough off. Healthy squamous lining then grows back. RFA effectively eradicates dysplasia and intestinal metaplasia.
Endoscopic mucosal resection (EMR) removes visible abnormal tissue, especially raised areas. A liquid solution is injected beneath the tissue to lift it, allowing precise removal with small instruments. EMR also provides tissue samples for analysis and is often used with other ablative therapies like RFA, particularly for larger Barrett’s areas.
Cryotherapy is an endoscopic method using extreme cold to destroy abnormal cells. Liquid nitrogen is sprayed onto diseased tissue, freezing and killing cells. The abnormal tissue sloughs off, and healthy cells regenerate. Multiple sessions may be needed. While these therapies remove changed cells, the condition can recur, requiring ongoing monitoring.
Acid-suppressing medications, like proton pump inhibitors (PPIs), manage acid reflux symptoms and prevent further esophageal damage. They reduce stomach acid, aiding esophageal healing after treatment. PPIs do not reverse Barrett’s tissue, but are recommended for long-term use to control reflux and potentially reduce cancer risk.
Managing the Condition Long-Term
Long-term management of Barrett’s esophagus involves regular surveillance and lifestyle adjustments to minimize recurrence and cancer risk. Even after successful endoscopic treatment, continued monitoring is important due to potential recurrence. Endoscopic surveillance includes periodic follow-up endoscopies with biopsies to check for returning Barrett’s tissue or dysplasia progression.
Surveillance intervals depend on the initial diagnosis, including dysplasia presence and grade, and Barrett’s segment length. Patients without dysplasia might have surveillance every three to five years; those with low-grade dysplasia may have more frequent endoscopies. After successful eradication, intervals are initially more frequent, gradually lengthening.
Lifestyle modifications also reduce acid reflux. Recommendations include maintaining a healthy weight, avoiding trigger foods (e.g., chocolate, coffee, fatty/spicy foods), and refraining from smoking and excessive alcohol. Eating smaller, more frequent meals, avoiding lying down immediately after eating, and elevating the head of the bed can also reduce esophageal acid exposure. Adhering to medical advice, including consistent PPI use and surveillance, supports sustained health.