Dysplasia of the esophagus refers to abnormal changes in the cells lining the swallowing tube connecting the mouth to the stomach. This precancerous condition involves cells that resemble cancer cells but cannot yet invade surrounding tissues or spread.
What is Esophageal Dysplasia?
Dysplasia describes abnormal cell growth and organization in the esophageal lining. These changes are strongly linked to Barrett’s esophagus, a condition where the normal esophageal lining is replaced by intestinal-like cells due to chronic acid reflux. This transformation is known as intestinal metaplasia.
Dysplasia in Barrett’s esophagus ranges from low-grade (LGD) to high-grade (HGD). LGD indicates mildly abnormal cells, representing an early precancerous stage.
HGD signifies severely abnormal cells within the esophageal lining. It is a more advanced precancerous stage than LGD and carries a higher risk of progressing to esophageal adenocarcinoma, a type of esophageal cancer. While dysplastic cells are abnormal, they do not yet spread throughout the body.
Recognizing Contributing Factors
Chronic gastroesophageal reflux disease (GERD) is a leading cause that can lead to esophageal dysplasia. Prolonged exposure of the esophageal lining to stomach acid can damage the normal squamous cells. This damage can lead to the replacement of these cells with intestinal-like cells, a condition known as Barrett’s esophagus.
Barrett’s esophagus is a direct precursor to dysplasia. Approximately 10% of individuals with chronic GERD may develop Barrett’s esophagus, and about 10% of those with Barrett’s esophagus may develop dysplasia. Other risk factors include long-standing heartburn, obesity, smoking, excessive alcohol consumption, diet, age, and being male.
Symptoms of esophageal dysplasia are often absent until advanced stages. Individuals experience symptoms related to underlying conditions like GERD, such as frequent heartburn, regurgitation of stomach contents, or difficulty swallowing.
How Dysplasia is Identified
Diagnosing esophageal dysplasia begins with screening at-risk individuals, such as those with long-standing GERD or diagnosed Barrett’s esophagus. An upper endoscopy visualizes the esophageal lining, using a flexible tube with a camera inserted through the mouth or nose.
If the esophageal lining appears abnormal during endoscopy, tissue samples are taken via biopsy. A pathologist then examines these samples under a microscope to classify the dysplasia.
Dysplasia is classified into low-grade (LGD) or high-grade (HGD) based on pathological examination. An expert pathological review confirms the presence and grade of dysplasia.
Management and Treatment Options
Managing esophageal dysplasia depends on its grade. For low-grade dysplasia (LGD), surveillance with regular endoscopic examinations and biopsies is recommended. Management of GERD with medication and lifestyle changes is also advised to reduce acid reflux.
For high-grade dysplasia (HGD), more aggressive interventions are pursued due to the increased risk of progression to esophageal cancer. Endoscopic therapy includes techniques like endoscopic mucosal resection (EMR) and ablation. EMR uses an endoscope to remove damaged or abnormal tissue.
Ablation techniques, such as radiofrequency ablation (RFA), use heat to destroy dysplastic cells. Cryotherapy, which uses extremely cold temperatures, is another ablative method to eliminate abnormal cells. These endoscopic methods aim to eradicate the dysplastic cells and the underlying Barrett’s esophagus, ideally leading to the replacement of the abnormal lining with normal esophageal tissue.
Surgical options, such as an esophagectomy (removing part of the esophagus), are considered a last resort or for cases where endoscopic therapy is not feasible or successful. This invasive procedure is reserved for advanced dysplasia or progression to early cancer. The goal of managing esophageal dysplasia is to prevent its progression to esophageal adenocarcinoma.