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.

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