Barrett’s esophagus is a medical condition characterized by intestinal metaplasia of esophageal epithelium. In other words, Barrett’s esophagus refers to a change in the cells lining the esophagus that occurs due to repeated exposure to stomach acid. What should be noted is that Barrett’s esophagus is a premalignant lesion that can result in esophageal adenocarcinoma.
Causes of Barrett’s esophagus
Causes of Barrett’s esophagus are not known exactly, but most commonly this medical condition is associated with reflux disease. It is estimated that Barrett’s esophagus occurs in about 10% of patients suffering from gastroesophageal reflux disease and presumably a longer exposure to gastric acidity leads to a higher risk of developing Barrett’s esophagus. It seems that patients who develop Barrett’s esophagus have a low pressure in the lower esophageal sphincter as demonstrated by manometric studies. Genetic factors may also be involved because not all patients who develop severe esophagitis also develop Barrett’s esophagus. It should be noted that there are cases, though rare, when Barrett’s esophagus is congenital.
Symptoms of Barrett’s esophagus
Patients with Barrett’s esophagus have the same symptoms as those suffering from gastroesophageal reflux disease, that is heartburn, acid regurgitation, salivation, laryngeal symptoms, dysphagia etc. The cardinal symptom of the disease is heartburn or retrosternal discomfort that occurs mainly in the first hour after heavy meals, high in fat, and is improved by ingestion of antacids. There are patients with Barrett’s esophagus who are asymptomatic, and the disease in this situation is diagnosed because of complications: stenosis, ulcers, cancer.
Barrett’s esophagus diagnosis
The gold standard in Barrett’s esophagus diagnosis is endoscopy along with biopsy and histopathological examination. Endoscopic recognition of this disease can sometimes be difficult, but there have been developed special techniques that improve endoscopic recognition, such as chromoendoscopy, which uses special stains.
Treatment of Barrett’s esophagus
Treatment of Barrett’s esophagus refers either to drugs or surgical treatment ( esophagectomy and endoscopic ablation). Drug treatment refers to administration of proton pump inhibitors in high doses (omeprazole, pantoprazole etc.) and for longer periods than in patients with gastroesophageal reflux disease.
Surgery is recommended for patients who do not respond to drugs and includes various antireflux techniques to relieve esophageal exposure to gastric acidity. Other options are endoscopic ablation or resection of esophageal intestinal metaplasia. Endoscopic ablation can be performed by several methods: thermal ablation, electrocoagulation, argon plasma coagulation, photodynamic therapy ect. Esophageal resection is indicated only for high-grade dysplasia in selected patients.