The change in the epithelial lining of the esophagus leads to a condition called Barrette’s esophagus. This condition develops due to the continuous exposure to the refluxed stomach acids, enzymes and bile of the esophagus. Norman Barrett was a thoracic surgeon who first described this condition. Thus, the condition is named after him, that is, Barrett esophagus.
What is Esophagus?
Esophagus or the gullet is a long muscular tube that extends from the throat down to the abdomen. It helps connecting the throat to the stomach. It has an inner mucosal lining that consists of squamous cells. These cells are similar to the cells found on the skin.
The food passes through the esophagus to reach the stomach. The presence of sphincter muscles at the junction of the esophagus and stomach prevent the food and stomach acid from leaking back up to the mouth. When this valve fails to close properly and allows acid reflux, it irritates the esophagus. This can damage the esophageal cells as they have no protection against the action of the acid.
What is Barrett’s Esophagitis?
Barrett’s esophagitis is also called as Barrett’s syndrome, Barrett’s Esophagus, or Columnar Epithelium Lined Lower Oesophagus (CELLO).When normal tissue lining of the esophagus (squamous epithelium) is replaced by abnormal cells (goblet cells), that are similar to the cells of the intestinal lining (lower gastrointestinal tract), it is called as Barrett’s Esophagitis. The process of change in the cellular structure is called as intestinal metaplasia. This is the major complication related to gastroesophageal reflux disease (GERD).
There are no specific symptoms related to Barrett’s esophagus. The symptoms are very similar to GERD. The condition increases the risk of the often fatal cancer of the esophagus.
Causes of Barrett’s Esophagitis
Chronic inflammation due to gastroesophageal reflux disease is the main cause of Barrett’s esophagitis. The stomach acid, bile, contents from the small intestine as well as pancreatic secreations can damage the cells at the lower end of esophagus. The acid irritates the esophagus and causes it to get inflamed. People who complain of pain and heartburn, that is, GERD are most likely to develop Barrett’s esophagus.
Other factors that increase the chances of developing Barrett’s esophagitis include:
- Chronic smoking
- Excessive alcohol intake
- Excessive consumption of spicy, acidic and fatty foods
- In some cases, hiatus hernia can cause acid reflux
Do All People with GERD Develop Barrett’s Esophagitis?
No. It is not necessary all people with GERD will develop esophagitis. However, any one suffering from long term GERD can develop esophagitis. About 1 in 10 people with GERD develop this condition. It is very common in men and people over the age of 50 years.
Symptoms Barrett’s Esophagitis
There are no particular symptoms related to Barrett’s Esophagitis. It is often discovered when one undergoes medical tests for some other condition. Symptoms, is any, commonly include:
- Difficulty swallowing food (dysphasia)
- Vomiting blood (hematemesis)
- Chronic heartburn
- Pain under the breastbone
- Weight loss due to inability to eat because of dysphasia
Diagnosis of Barrett's esophagitis is made with the help of upper gastrointestinal endoscopy. It is a procedure, where a long fiber optic cable is passed through the mouth. The cable captures images of the mouth, esophagus, stomach and duodenum with the help of a camera fitted in the end. Normal lining of the esophagus appears pale, while that of Barrett’s mucosa is red in color. Biopsy will be conducted of the tissues, to confirm presence of Barrett's esophagus.
Once the biopsy is conducted, and presence of Barrett’s mucosa is confirmed, the tissue is categorized into four general categories. These categories include:
- Non-dysplastic (requires annual endoscopic observation)
- Low-grade dysplasia (requires annual endoscopic observation)
- High-grade dysplasia (requires radiofrequency ablation)
- Carcinoma (requires surgery)
Treatment of Barrett’s Esophagitis
The treatment aims at controlling the acid reflux and its related symptoms. This can be achieved by:
- Prescription of antacids, proton pump inhibitors, histamine receptor blockers.
- Changes in diet by avoiding spicy, fatty or acidic foods
- Losing weight in case of obesity
- Quit smoking and reducing the amount of alcohol intake
- Fundoplication, a procedure to strengthen the sphincter mucles present at the end of esophagus
- If there is risk of developing cancer, one may be advised removal of affected area by endoscopic mucosal resection or surgical resection.
- Abnormal cells in the esophagus can be destroyed with the help of radiofrequency ablation (RFA), cryotherapy, etc.
It is very important to know if one suffers from Barrett’s esophagus as it can lead to cancer. People with Barrett’s are therefore advised endoscopy tests annually, called as surveillance endoscopy to keep a tap on the premalignant phase, that is, dysplasia. Remember only 5 to 10% people with GERD develop Barrett’s esophagitis. Thus, make sure you discuss treatment and management options for Barrett’s esophagus with your doctor in detail.
Written by: Saptakee sengupta
Date last updated: February 02, 2015