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Barrett Esophagus

In Barrett esophagus, the lower part of the esophagus, which connects the mouth and stomach, is affected. It is caused by chronic exposure to stomach acid, which damages and changes the normal cells of the esophagus into abnormal cells that resemble those of the intestine. Barrett esophagus can increase the risk of developing esophageal cancer, a serious and potentially fatal disease, which is caused by intestinal metaplasia.

Causes of Barrett Esophagus

GERD, a condition that occurs when the lower esophageal sphincter (LES), which acts as a valve between the esophagus and the stomach, becomes weak or relaxes abnormally, is the most common cause of Barrett esophagus. As a result, stomach acid and bile can flow back into the esophagus, causing irritation, inflammation, and injury to the lining of the esophagus, which can lead to Barrett esophagus.

GERD and Barrett esophagus can be caused by factors such as:

  • Obesity: Being overweight or obese can put pressure on the abdomen and weaken the LES.

  • Hiatal hernia: This is a condition that occurs when part of the stomach bulges through an opening in the diaphragm, which is a muscle that separates the chest from the abdomen. This can impair the function of the LES and allow acid reflux.

  • Smoking: Smoking can damage the mucous membrane of the esophagus and reduce saliva production, which helps neutralize acid. Smoking can also relax the LES and increase acid production in the stomach.

  • Alcohol: Alcohol can irritate and inflame the esophagus and relax the LES. Alcohol can also increase acid production in the stomach.

  • Diet: Eating foods that are spicy, acidic, fatty, or caffeinated can trigger or worsen acid reflux. Eating large or late meals can also increase pressure on the LES and delay stomach emptying.

  • Medications: Some medications that can affect the LES or increase acid reflux are nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen; calcium channel blockers, such as nifedipine or diltiazem; antihistamines, such as diphenhydramine or loratadine; or antidepressants, such as amitriptyline or fluoxetine.

Symptoms of Barrett Esophagus

There are no specific symptoms associated with Barrett esophagus, but it can cause or worsen GERD symptoms. GERD symptoms include:

  • Heartburn: This is a burning sensation in the chest or throat that occurs when stomach acid flows back into the esophagus. It can be worse after eating or lying down.

  • Regurgitation: This is a feeling of acid or food coming back up into the mouth or throat. It can cause a sour or bitter taste in the mouth.

  • Dysphagia: This is difficulty swallowing food or liquids due to narrowing or obstruction of the esophagus.

  • Chest pain: This is pain or discomfort in the chest that may radiate to the neck, jaw, or arm. It can be mistaken for a heart attack.

  • Cough: This is a reflex action that occurs when acid irritates the throat or lungs. It can be dry or productive.

  • Hoarseness: This is a change in voice quality due to inflammation or damage to the vocal cords.

  • Sore throat: This is pain or irritation in the throat due to acid exposure.

  • Asthma: This is a condition that causes inflammation and narrowing of the airways, leading to wheezing, shortness of breath, coughing, or chest tightness. It can be triggered or worsened by acid reflux.

Diagnosis of Barrett Esophagus

Your doctor will ask about your medical history, your family history, your symptoms, and your lifestyle habits in order to diagnose Barrett esophagus. The doctor will also perform a physical exam and check your vital signs, chest, abdomen, and throat. Some tests may also be ordered to confirm the diagnosis and assess the severity of your condition.

  • Endoscopy: This test involves inserting a thin, flexible tube with a light and camera (endoscope) into your esophagus and stomach through your mouth. By using the endoscope, your doctor can examine your digestive tract and look for signs of inflammation, ulcers, or abnormal cells. It is also possible for your doctor to take a biopsy of your esophagus for further analysis.

  • Over a period of 24 hours, you will be able to find out how much and how often your esophagus experiences acid reflux. During an endoscopy, your esophagus is attached to a small device (pH probe) or a wireless capsule (Bravo system) is placed. During the test, you will keep a diary of your symptoms and activities and record the pH levels in your esophagus. The device or capsule will record the pH levels in your esophagus and transmit the data to a recorder around your waist or chest.

  • The manometry test measures the pressure and function of your esophagus and LES by inserting a thin, flexible tube into your nose and into your esophagus with sensors (manometer). As you swallow food or water, the tube records how your esophageal muscles contract and relax.

Treatment of Barrett Esophagus

Barrett esophagus is treated according to its stage and severity, as well as your preferences and goals. Treatment options include:

  • Medications: These are drugs that can help reduce or neutralize the acid production in your stomach and prevent or relieve the symptoms of GERD. They include antacids, such as calcium carbonate (Tums) or magnesium hydroxide (Milk of Magnesia); histamine-2 blockers, such as ranitidine (Zantac) or famotidine (Pepcid); proton pump inhibitors, such as omeprazole (Prilosec) or esomeprazole (Nexium); or prokinetics, such as metoclopramide (Reglan) or domperidone (Motilium).

  • Lifestyle changes: These are changes that can help prevent or reduce acid reflux and improve your quality of life. They include losing weight if you are overweight or obese; quitting smoking if you smoke; limiting alcohol intake if you drink; avoiding foods that trigger or worsen acid reflux, such as spicy, acidic, fatty, or caffeinated foods; eating smaller or more frequent meals; raising the head of your bed by 6 to 8 inches; and not lying down for at least 3 hours after eating.

  • Endoscopic therapy: This is a type of therapy that involves using an endoscope to perform various procedures on your esophagus to treat Barrett esophagus or prevent its progression to cancer. They include radiofrequency ablation, which uses heat to destroy the abnormal cells; cryotherapy, which uses cold to freeze and kill the abnormal cells; endoscopic mucosal resection, which uses a snare or suction device to remove the abnormal tissue; or photodynamic therapy, which uses a light-sensitive drug and laser to destroy the abnormal cells.

  • Surgery: This is an option for people who have severe or high-grade Barrett esophagus that does not respond to other treatments or who have developed esophageal cancer. It involves removing part or all of the esophagus (esophagectomy) and reconstructing it with a segment of the stomach or colon.

Prevention of Barrett Esophagus

There are some steps that can be taken to reduce the risk of developing Barrett esophagus or to slow its progression, including:

  • The treatment of GERD involves managing the condition that causes acid reflux and damages the lining of the esophagus, resulting in Barrett's esophagus. This may require medications, lifestyle changes, endoscopic therapy, or surgery.

  • In order to detect Barrett esophagus or esophageal cancer early and monitor any changes in the condition, patients undergo regular endoscopy and biopsy. The frequency and interval of screening and surveillance depends on your risk factors, symptoms, and diagnosis.

  • Taking medications that may prevent or delay the development of Barrett's esophagus or esophageal cancer is known as chemoprevention. A number of these include aspirin, which decreases inflammation and inhibits cell growth, statins, which lower cholesterol and modulate cell signaling, or metformin, which regulates blood sugar and metabolism.

Conclusion

Barrett esophagus is a condition that affects the lining of the lower part of the esophagus, the tube connecting the mouth to the stomach. As a result of chronic stomach acid exposure, normal esophagus cells become abnormal, resembling those of the intestines. This process is called intestinal metaplasia. As a result of Barrett esophagus, esophageal cancer can occur, which is a serious and potentially fatal fatality. Symptoms and physical exam can help a doctor diagnose Barrett esophagus based on your medical history, family history, symptoms, and physical exam. The doctor may also order some tests to confirm the diagnosis. There are several ways to treat Barrett esophagus, depending on its stage and severity, your preferences, and your goals, such as medications, lifestyle changes, endoscopic therapy, and surgery.

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