1532 Health Library | Health and Wellness | Wellmont Health System
  • Barrett's Esophagus

    Definition

    The esophagus is a tube that carries food from your mouth to your stomach. Chronic esophagitis is inflammation of the esophagus. Barrett's esophagus is a complication of chronic esophagitis.
    Barrett's esophagus is a change in the cells that line the esophagus. Normal cells are flat-shaped (squamous) cells. Barrett's esophagus cells are shaped like a column. This cell change is called metaplasia. It is a premalignant phase that may result in cancer of the esophagus if it is not treated.

    Causes

    The exact cause of Barrett's esophagus is not known. It may result from damage to the esophagus caused by the chronic reflux of stomach acid. Frequent or chronic reflux of stomach acid into the esophagus is called gastroesophageal reflux disease or GERD.
    Gastroesophageal Reflux
    Gastroesophageal Reflux
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    Risk factors that increase your chances of getting Barrett's esophagus include:

    Symptoms

    Barrett's esophagus does not directly produce symptoms. Some people with GERD may have the following:
    • Heartburn
    • Chest pain
    • Nausea or vomiting
    • Blood in vomit or stool
    • Sore throat or chronic cough
    • Hoarse voice
    • Sour taste in mouth (acid reflux)
    • Shortness of breath or wheezing
    • Difficulty or pain with swallowing (dysphagia)

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

    Treatment

    The cell changes from Barrett's esophagus are permanent once they occur. The goal of treatment is to prevent further damage by stopping the reflux of acid from the stomach. Treatment may include:

    Medications

    The following types of medicines may be prescribed:
      H 2 blockers, such as:
      • Cimetidine (Tagamet)
      • Ranitidine (Zantac)
      • Famotidine (Pepcid)
      • Nizatidine (Axid)
      Proton pump inhibitors, such as:
      • Omeprazole
      • Lansoprazole
      • Pantoprazole (Protonix)
      • Rabeprazole (Aciphex)

    Surgery

    Your doctor may recommend surgery if the disease is severe or the medication is not helpful. Surgical options may include:
    • Fundoplication—part of the upper stomach is wrapped around the esophagus; this is done to reduce further damage caused by GERD
    • Esophagectomy—removal of the Barrett's segment of the esophagus
    • Removal of the abnormal lining by several methods: photodynamic therapy (PDT), argon plasma coagulation (APC), multipolar electrocoagulation (MPEC), heater probes, lasers, cryotherapy, and radiofrequency ablation. (Most of these techniques are investigational, except for PDT.)

    Monitoring

    Your doctor may recommend endoscopy every 1-3 years to monitor the esophagus for early signs of cancer.

    Prevention

    The best way to prevent Barrett's esophagus is to reduce and/or treat the reflux of stomach acid into the esophagus. This is usually caused by GERD. Self-care measures for GERD include:
    • Do not smoke. If you smoke, quit.
    • If you are overweight, lose weight.
    • Raise the head of your bed onto 4-6 inch blocks.
    • Avoid clothes with tight belts or waistbands.
    • Avoid foods that cause heartburn. These include alcohol, caffeinated beverages, chocolate, and foods that are fatty. This also includes spicy or acidic foods such as citrus or tomatoes.
    • Eat 4-6 small meals per day.
    • Do not eat or drink for 3-4 hours before you lie down or go to bed.

    RESOURCES

    National Institute of Diabetes and Digestive and Kidney Diseases http://www.niddk.nih.gov

    The Society of Thoracic Surgeons http://www.sts.org

    CANADIAN RESOURCES

    Canadian Society of Intestinal Research http://www.badgut.com

    Health Canada http://www.hc-sc.gc.ca

    References

    Barrett esophagus. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 3, 2012. Accessed November 12, 2012.

    Cameron AJ. Barrett's esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999;94(8):2054-2059.

    Pereira-Lima JC, Busnello JV, Saul C. High power setting argon plasma coagulation for the eradication of Barrett's esophagus. Am J Gastroenterol. 2000;95(7):1661-1668.

    Rajan E, Burgart LJ, Gostout CJ. Endoscopic and histologic diagnosis of Barrett esophagus. Mayo Clin Proc. 2001;76(2):217-225.

    Sampliner RE. Ablative therapies for the columnar-lined esophagus. Gastroenterol Clin North Am. 1997;26(3):685-694.

    Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996;44(5):532-535.

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