Barrett’s Esophagus

Barrett’s Esophagus

What is Barrett’s Esophagus?

  [caption id="attachment_2112" align="alignright" width="410"]Barrett's Esophagus is the primary risk factor for esophageal cancer Infographic developed by Medtronic[/caption] Barrett’s esophagus describes a condition where the cells lining the lower esophagus change. The esophagus is the swallowing tube that carries food from the mouth to the stomach. There are 800,000 Canadians living with this disorder – nearly half of these have no symptoms. It is believed those living with Barrett’s esophagus are at an increased risk of developing esophageal cancer so it is important that those at risk be tested for the disorder.

Who is at risk of Barrett’s esophagus?

Risk factors include being older than 50 years, male, Caucasian, family history and having experienced reflux symptoms for longer than one year. Diagnosis of Barrett’s esophagus requires that suspected patients undergo endoscopy and biopsy. Many questions about this disorder remain unanswered. We do not fully understand what predisposes some people to develop the condition. Accordingly, it is not known whether all people with gastroesophageal reflux disease (GERD) should be tested for Barrett’s esophagus or only those with specific risk factors.  

Questions to ask your doctor about Barrett's esophagus

What to ask your doctor:

Create a list of 3 to 6 questions to ask your doctor during your appointment. Specifically, you may want to ask your doctor some of the following:

Questions about Testing

  • What tests do I need to do? What should I expect?
  • How long do the tests take?
  • Will I be awake? If not, how long will I be asleep?
  • Do the tests require samples for a biopsy?
  • Are there potential complications from the tests?
  • What if I don’t take the tests?
  • Is there anything that I need to do to prepare for the procedure?
  • How long will it take for me to recover?
  • How soon will I know the results of the tests?
  • What is my risk for Barrett’s esophagus?
  • What is my risk for esophageal cancer?
  • Will I need regular exams in the future? If so, how often and for how long?
  • Am I at risk for cancer?

Questions about diagnosis and treatment:

  • Do I have Barrett’s esophagus? If so, how serious is it?
  • How was the diagnosis confirmed?
  • Do you recommend another exam?
  • How much of my esophagus is affected?
  • Am I at risk of cancer?
  • What are my treatment options?
  • Which treatment reduces my progression risk the most?
  • Will you conduct the treatment, or will you refer me to someone else?
  • What result do you expect from the treatment? How will I know that it is working?
  • Will the treatment cure my condition? If not, are there other treatments that might?
  • What can I expect of the treatment?
  • Will I need to stay in the hospital? If so, how long?
  • Are there any possible side effects? Are there any that I should report to you immediately?
  • What do I need to do to prepare for the treatment?
  • Will I need to do anything after the treatment?
  • Will I still need to continue my medications?
  • Will there be any additional follow-up testing after the treatment?
  • What will happen if I decide to opt out of treatment?
  • What will be the risk of progressing to cancer if I decide to opt out of treatment?
 

Signs & Symptoms

[caption id="attachment_2120" align="aligncenter" width="798"]Is Barrett's esophagus common in people with GERD? Infographic developed by Medtronic[/caption]

Is Barrett's esophagus more common in people with GERD?

Yes, Barrett’s esophagus is more common in people with GERD. Though Barrett's esophagus often times does not have prominent symptoms, people who suffer from GERD may experience symptoms such as:

  • heartburn,
  • regurgitation,
  • belching
  • chest pain.
Barrett’s esophagus affects more men than women and is more common among Caucasians. It is typically diagnosed by endoscopy. Endoscopy is a safe outpatient procedure where a flexible tube with a camera is passed through the mouth to look at the lining of the esophagus and take a small tissue sample (biopsy). Barrett's esophagus is more common in people with GERD

What causes Barrett’s esophagus?

Barrett’s esophagus is more common in people with gastroesophageal reflux disease (GERD). GERD is a common condition where stomach contents, including acid and bile, regurgitate into the esophagus. It has been suggested that this disorder is the body’s response and attempt to protect the esophagus from the irritating effects of acid and bile by changing to a different lining.

Unfortunately, this condition is believed to increase the risk of developing esophageal cancer. Most physicians recommend that people suffering from this disorder undergo endoscopy about every two years. This allows doctors to screen for cancer and allows for early treatment. In some cases, more frequent endoscopy is recommended.

What happens if Barrett’s esophagus goes untreated?

Patients with Barrett’s esophagus have up to 60 times higher risk of developing esophageal cancer (EAC). EAC has a 5-year survival rate of only 14%. Barrett’s esophagus patients with any of the above risk factors should speak to their physician about the most effective treatment to reduce their risk.

Tests & Treatments

How is Barrett's esophagus diagnosed?

There are a number of ways to treat Barrett's esophagus, but first, your doctor will want to provide you with a firm diagnosis. If you are showing persistent symptoms of GERD your doctor may want to perform an endoscopy.

Barrett’s esophagus is diagnosed by endoscopy, a safe outpatient procedure where a flexible tube with a camera is passed through the mouth to look at the lining of the esophagus and take a small tissue sample (biopsy). Often, the endoscopist can notice a change in the appearance of the lining of the esophagus that suggests the presence of Barrett’s esophagus. However, the diagnosis can only be confirmed by carefully examining the biopsy under a microscope.

Barrett’s esophagus is believed to increase the risk of developing esophageal cancer. Most physicians recommend that people with Barrett’s esophagus undergo endoscopy about every two years to screen for cancer and allow early treatment. In some cases, more frequent endoscopy is recommended.

Medications:

Here are some medications to reduce stomach acid and control the symptoms of GERD include antacids, proton pump inhibitors, and H2 receptor antagonists:
  • Antacids work by neutralizing the acid that is present in the stomach. Antacids are of value for patients who have intermittent symptoms that require quick relief. However, to treat an ulcer frequent dosing is necessary and more effective medications are now present.
  • Proton Pump Inhibitors (PPIs)are the most effective medications for lowering acid and treating ulcer disease. They work by blocking proton pumps that secrete acid in the stomach and block acid the strongest.
  • H2 receptor antagonists work by blocking histamines that stimulate acid secretion in the stomach. These are prescriptions drugs but some are now available as over the counter medications that do not require a doctor’s prescription.

How do you treat Barrett's esophagus?

Treatment options vary by the stage or severity of Barrett’s esophagus and the doctor will recommend the best option.

Surveillance

One way a doctor may recommend Barrett's esophagus be treated following diagnosis is surveillance with endoscopy and biopsy. This essentially means your doctor will perform an examination of your esophagus and sample the affected tissue. This will be done at various intervals to monitor disease progression to more advanced stages. The frequency of these tests may vary depending on the stage or severity of Barrett’s esophagus.

Endoscopic Options

A number of endoscopic therapy options are available to treat Barrett's esophagus. Endoscopic therapy options offer a variety of means to remove the diseased lining of the esophagus via resection of the tissue.

Radiofrequency Ablation

Radiofrequency ablation (RFA) uses heat to treat Barret's esophagus by removing affected tissue while preserving the underlying healthy tissue. RFA is a proven technology that reduces the relative risk of disease progression to esophageal cancer. Watch the below animation developed by Medtronic to see how the BarrxTM radiofrequency ablation system works and learn about what you can expect from the procedure. [embed]https://www.youtube.com/watch?v=s9khaVztuRo[/embed]
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Reference 1: Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009;360:2277-88,
Reference 2: Phoa KN, van Vilsteren FG, Pouw RE, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014 Mar 26;311(12):1209-17
Reference 3: Wolf WA, Pasricha S, Cotton C, et al. Incidence of Esophageal Adenocarcinoma and Causes of Mortality after Radiofrequency Ablation of Barrett’s esophagus. Gastroenterology. 2015;149:1752-1761.)
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Statistics

Statistics on Barrett's esophagus:

[caption id="attachment_2125" align="alignright" width="206"]Infographic on Barrett's esophagus statistics Click to view full infographic[/caption]
  • Barrett’s esophagus describes a condition where the cell lining of the lower esophagus changes.
  • Barrett’s esophagus may lead to adenocarcinoma of the esophagus.
  • About 0.5% of people with Barrett’s esophagus develop esophageal cancer. (Canadian Cancer Society 2018)
  • The estimated prevalence of Barrett’s esophagus in the population varies between 2 and 7%. (Macías-García et al. 2016)
  • Barrett’s esophagus is believed to be the result of chronic gastroesophageal reflux disease (GERD). Around 10 to 15% of GERD cases will develop into Barrett’s esophagus. (Schlottmann et al. 2018)
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Citations:
Canadian Cancer Society. 2018. Esophageal cancer – Precancerous conditions of the esophagus. 
Macías-García F and Domínguez-Muñoz JE. Update on management of Barrett’s esophagus. World J Gastrointest Pharmacol Ther. 2016 May 6;7(2):227-34.
Schlottmann F et al. Gastroesophageal refux and Barrett’s esophagus: A pathway to esophageal adenocarcinoma. Updates Surg. 2018 Jul 23.

Barrett’s Esophagus Infographic

FAQs

Frequently asked questions about Barrett’s esophagus

What are the symptoms?

There are no symptoms specific to Barrett’s esophagus, other than the typical symptoms of gastroesophageal reflux disease (or GERD). These include heartburn, chest pain, and regurgitation.

Who is at risk?

Patients with GERD are at an increased risk for developing Barrett’s esophagus. Caucasian males over the age of 50 with chronic reflux symptoms or heartburn have a higher risk for the disease. Receiving a diagnosis at a young age or having a family history of Barrett’s esophagus also contribute to one’s risk. Being overweight and obese (body mass index 25-30) increases a person’s risk to develop esophageal cancer by almost two times.

How is Barrett’s esophagus diagnosed?

Barrett’s esophagus cannot be diagnosed by symptoms. A diagnosis of Barrett’s esophagus is currently dependent on an upper endoscopy performed by a gastroenterologist. This procedure enables the doctor to directly visualize the esophagus and take tissue samples of the esophageal tissue.

How does a doctor follow a Barrett’s Esophagus patient?

If a Barrett’s esophagus is identified then it is important to follow the patient with regular gastroscopies to obtain biopsies to see if there is any associated dysplasia or early cancer that is arising in the Barrett’s esophagus that can be treated before a more serious problem arises. The follow up program will vary depending on the biopsy results. If one identifies a very high grade of dysplasia or early cancer then there are several options of treatment. These include using radiofrequency ablation system to eradicate the dysplastic tissue while preserving the healthy tissue underneath or surgery where the entire esophagus is removed.

Are treatment options available?

Yes, treatment with the radiofrequency ablation technology has been shown to reduce disease progression by removing precancerous tissue from the esophagus. Barrett’s esophagus patients treated with radiofrequency ablation are less likely to progress to esophageal cancer compared to patients who undergo surveillance.

I’ve been told that I have Barrett’s Esophagus. Does this mean I will develop esophageal cancer?

Sometimes the cells at the lower end of the esophagus are replaced by columnar cells resembling those of the stomach and small intestine. This change is referred to as Barrett’s esophagus. This disorder is believed to increase the risk of developing esophageal cancer. It can be controlled with medications. Your physician need to carefully monitor the status of the cells in your esophagus to minimize the likelihood of developing cancer.

If I have Barrett’s esophagus, will I develop esophageal cancer?

Barrett’s esophagus is believed to increase the risk of developing esophageal cancer. However, the true risk of developing esophageal cancer in people with Barrett’s esophagus remains controversial. Most physicians recommend that people with Barrett’s esophagus undergo endoscopy about every two years to screen for cancer and allow early treatment. In some cases more frequent endoscopy is recommended.

Radiofrequency Ablation Patient Story

Mary shares her experience of being diagnosed with Barrett’s Esophagus and electing treatment with radiofrequency ablation.

To learn more about radiofrequency ablation check out our treatment page and Medtronic's patient information. [embed]https://www.youtube.com/watch?v=9Yh0wjZcBqc[/embed]

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