Barrett's Esophagus


If you have Barrett’s esophagus you should have a thorough discussion with your physician about treatment options available to you. To find a qualified gastroenterologist, call our Physician Referral Service at (561) 263-5737 or click HERE.
 

What is Barrett's esophagus?

Barrett’s esophagus is a pre-cancerous condition affecting the lining of the esophagus, the swallowing tube that carries food and liquids from the mouth to the stomach. It is estimated that more than three million adults in the United States over the age of 50 have this disorder. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more often than men of other races.
Barrett’s esophagus is caused by injury to the esophagus from the chronic backwash of stomach contents that occurs with gastroesophageal acid reflux or GERD. This produces symptoms such as heartburn, regurgitation and chest pain. In some patients with GERD, the normal esophageal cells are damaged. Over time, this damage can result in inflammation and genetic changes that cause the cells to become altered. The tissue takes on a different appearance and microscopically is no longer esophageal tissue, but rather becomes intestinal tissue.
If you experience symptoms of GERD more than three times per week, you should speak with your physician about the next steps to take.


How is Barrett's esophagus diagnosed?

Barrett’s esophagus is diagnosed by undergoing an upper endoscopy procedure. An endoscopy is a nonsurgical procedure, performed by a gastroenterologist using conscious sedation. A biopsy will be taken and the tissue sent to a pathologist for evaluation.


What are the different types of Barrett's esophagus?

There are several different types or “grades” of Barrett’s esophagus which are determined by the pathologist after reviewing the biopsy tissue.
These “grades” include:

  • Intestinal metaplasia (IM) without dysplasia
  • IM with low-grade dysplasia
  • IM with high-grade dysplasia

Dysplasia is an abnormality of a tissue or cell that makes it more cancer-like. While the presence of dysplasia may raise the risk of cancer, it is not considered cancer. However, higher grades of dysplasia may be considered cancer if there are signs of tissue invasion.


What are the risks of Barrett's esophagus?

A diagnosis of Barrett’s esophagus increases your risk for developing esophageal cancer. Patients with low-grade and high-grade dysplasia are at the highest risk. Esophageal cancer is one of the fastest rising cancers in the United States. The incidence is rising faster than breast cancer, prostate cancer and melanoma. While the average age of diagnosis is 50, it is difficult to determine when the disease developed and how long a patient has been affected.


How is Barrett's esophagus managed and treated?

The management of Barrett’s esophagus depends on the type or “grade” and will be determined by your physician. Patients with high-grade dysplasia may be referred for more definitive therapy immediately. Treatment options include endoscopic and surgical therapy to eliminate the Barrett’s tissue completely. Radiofrequency ablation (RFA) therapy has been shown to be a safe and effective treatment option for Barrett’s esophagus.


HALO Radiofrequency Ablation

The Frenchman's Creek Center for Excellence in Digestive Health utilizes the HALO radiofrequency ablation technology. Radiofrequency energy (radio waves) is delivered through a catheter to the esophagus to remove diseased tissue -- this is called ablation. Ablation is a technique that heats tissue until it is no longer viable or alive. Physicians have used various forms of ablation to treat a number of cancerous and precancerous conditions and control bleeding. The HALO ablation technology is a very specific type of ablation, in which heat and energy are delivered in a highly-controlled, precise manner.
Barrett’s esophagus tissue is very thin which makes it a good candidate for removal with ablation. Delivery of ablative energy using the HALO ablation technology is capable of achieving complete removal of the diseased tissue without damage to the normal underlying structures.


Follow-Up

According to published clinical trials, patients require two to three procedures to achieve a complete remission of Barrett’s esophagus. Each patient is different, depending on the length and severity of the Barrett’s esophagus. After initial treatment, the physician may schedule a follow-up appointment within two-three months to evaluate the response to therapy. An upper endoscopy may be performed at that time to determine if any Barrett’s tissue remains and if additional therapy is needed.
Regular monitoring is recommended even after radiofrequency ablation. This includes having an upper endoscopy on a regular basis throughout life. The physician will determine how often evaluation is needed based on the type of Barrett’s.
Successful treatment of Barrett’s esophagus tissue does not cure the GERD or acid reflux that caused Barrett’s. The physician will determine the best management of long-term acid reflux therapy.


What happens if Barrett's esophagus goes untreated?

If left untreated, Barrett’s esophagus can advance to low or high-grade dysplasia and can result in the development of esophageal cancer in some patients. The majority of patients who develop advanced esophageal cancer are unaware that they have Barrett’s esophagus. If you experience symptoms associated with chronic acid reflux or GERD, it is important to see your physician for a discussion and evaluation of those symptoms.