Precancerous condition in which the tissue lining the esophagus is replaced with tissue similar to the intestinal lining

Barrett’s esophagus is a precancerous condition in which the tissue lining the esophagus is replaced with tissue similar to the intestinal lining.

Barrett’s esophagus is estimated to affect 1.6 to 6.8 percent of the population. Barrett’s esophagus primarily affects men, particularly Caucasians, with 55 being the average age of diagnosis. 

The exact cause of Barrett’s is unknown and determining when the problem started is usually difficult. However gastroesophageal reflux disease (GERD) is a risk factor, as chronic GERD may damage the cells in the esophagus. Between 5-10 percent of people with GERD develop Barrett’s esophagus. Other risk factors include obesity—specifically, high levels of belly fat—smoking and possibly genetics.

People with Barrett’s esophagus are at increased risk for a rare type of cancer called esophageal adenocarcinoma.

Diagnosis

Barrett’s esophagus is often diagnosed when a person has an upper GI endoscopy for GERD symptoms. Some healthcare providers may also recommend that people with multiple risk factors for this condition be tested. If precancerous cells appear in the Barrett’s tissue (dysplasia), your doctor may recommend periodic monitoring (surveillance) via an upper GI endoscopy with biopsy to watch for any changes. Barrett’s esophagus may be present for many years before cancer develops.

Treatment

Your doctor will discuss treatment options based on your overall health, whether dysplasia is present, and, if so, the severity of the dysplasia. Treatment options include medication, endoscopic ablative therapies, endoscopic mucosal resection and surgery.

People with Barrett’s esophagus who have GERD are treated with acid-suppressing medications, most commonly proton pump inhibitors. These medications are used to prevent further damage to the esophagus and, in some cases, heal existing inflammation damage but the Barrett’s condition will remain unchanged. Anti-reflux surgery may be considered for people with GERD symptoms who do not respond to medications. 

Endoscopic ablative therapies use different techniques to destroy the dysplastic cells in the esophagus. The body should then begin making normal esophageal cells. The procedures most often used are photodynamic therapy and radiofrequency ablation. Esophagectomy, surgical removal of the affected sections of the esophagus, is an alternative; however, endoscopic therapies are preferred due to fewer complications.

Endoscopic Mucosal Resection

Endoscopic mucosal resection involves lifting the Barrett’s lining and injecting a solution underneath or applying suction to the lining and then cutting the lining off. The lining is then removed with an endoscope. If endoscopic mucosal resection is used to treat cancer, an endoscopic ultrasound (EUS) is done first to make sure the cancer involves only the top layer of esophageal cells. EUS uses a device, called a transducer that bounces safe, painless sound waves off organs to create an image of their structure. Complications can include bleeding or tearing of the esophagus. Endoscopic mucosal resection is sometimes used in combination with photodynamic therapy.

Photodynamic Therapy

Photodynamic therapy uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in the esophagus. When porfimer is exposed to laser light, it produces a form of oxygen that kills nearby cells. Porfimer is injected into a vein, and the person returns 24 to 72 hours later to complete the procedure. The laser light passes through the endoscope and activates the porfimer to destroy Barrett’s tissue in the esophagus. Complications of photodynamic therapy include sensitivity of the skin and eyes to light for about six weeks after the procedure; burns, swelling, pain, and scarring in nearby healthy tissue; and coughing, trouble swallowing, stomach pain, painful breathing, and shortness of breath.

Radiofrequency Ablation

Radiofrequency ablation uses radio waves to kill precancerous and cancerous cells. An electrode mounted on a balloon or endoscope delivers heat energy to the Barrett’s tissue. Complications include chest pain, cuts in the mucosal layer of the esophagus, and strictures—narrowing of the esophagus. Clinical trials have shown a lower incidence of side effects for radiofrequency ablation compared with photodynamic therapy.

Why Choose Ohio State

Why seek treatment at The Ohio State University Wexner Medical Center?

Ohio State is recognized by U.S.News & World Report as one of the nation's highest performing hospitals in gastroenterology and GI surgery.

In 2014, Ohio State's Wexner Medical Center received the "2014 Gastrointestinal Care Excellence Award" from Healthgrades, the leading online resource for information about physicians and hospitals. The award recognizes hospitals for superior outcomes in bowel obstruction treatment, colorectal surgeries, gallbladder removal, esophageal/stomach surgeries, treatment of gastrointestinal bleeds, treatment for pancreatitis and small intestine surgeries. Patients who have these treatments or surgeries at these nationally recognized hospitals have a lower risk of dying or experiencing a complication during their hospital stay.

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