Almost everyone has heartburn occasionally and it is nothing to be concerned about. However, heartburn that is severe or recurring over a long period of time can be harmful – this is known as Gastroesophageal Reflux Disease (GERD). If GERD is untreated, there is constant acid irritation to the lining of the esophagus and can cause complications. About 1 in 10 patients with GERD have Barrett’s Esophagus, which can be serious and may lead to cancer of the esophagus.
Click on the statements/questions below to reveal the answers to the causes, symtoms and signs of this particular disease.
Named after Norman Rupert Barrett, this is a complication of severe chronic GERD involving changes in the cells of the tissue that line the bottom of the esophagus. These changes are a forerunner to cancer of the lower esophagus, known as adenocarcinoma.
In time, the cells may develop abnormal changes known as dysplasia. Over a period of 2-5 years, the “grade” of dysplasia may progress to high grade and eventually cancer. This occurs in approximately 1-5% of Barrett’s esophagus patients. Anecdotal evidence suggests that this cancer is becoming more prevalent – especially in white males – perhaps due to the fact that prescribed drugs may mask the symptoms.
On a related note, cancer of the upper esophagus (squamous cell cancer), which is usually related to alcohol and smoking, seems to be decreasing.
Barrett’s esophagus is found three times more often in males. In some cases it is congenital (present at birth). However, current evidence is strong that it more often develops as the result of long-term GERD. Patients with Barrett’s usually have symptoms similar to those produced by GERD (heartburn and acid reflux), but may also have other complications of GERD including esophageal peptic ulcers and stricture (narrowing of the esophagus that results from scarring).
Barrett’s esophagus is diagnosed with an exam called an upper endoscopy or EGD (esophagogastroduodenoscopy). Biopsies are performed on pieces of esophageal tissue to look for abnormal cells. If the results show “indefinite dysplasia”, medical treatment of the GERD is intensified and follow-up biopsies will be taken in 6-12 months. If dysplasia is definite, a treatment plan to address the changing cells will be determined.
A barium X-ray is not accurate for detecting Barrett’s esophagus.
Currently, there are no medications to reverse Barrett’s esophagus. However, it appears that treating the underlying GERD may slow the progression of the disease and prevent complications. Here are some things you can do to help reduce acid reflux and strengthen the LES (Lower Esophageal Sphincter).
- Avoid eating anything within 3 hours of bedtime.
- Avoid smoking and tobacco products. Nicotine in the blood weakens the LES.
- Avoid chewing gum or hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
- Reduce consumption of fatty foods, milk products, chocolate, mints, caffeine, carbonated beverages, citrus fruits and juices, tomato products, pepper seasoning and alcohol (especially red wine).
- Eat smaller meals. Avoid tight clothing or bending over after eating.
- Review all medications with your physician, especially your gastroenterologist. Certain drugs can weaken the LES.
- Elevate the head of the bed about 6-8 inches, using blocks under the mattress or bed. This helps to keep acid in the stomach. Propping yourself up on extra pillows actually has the opposite effect as it tends to bend the body at the waist, pushing more fluid back up into the esophagus.
- Maintain a healthy weight.
Select the section below to learn about medications used to treat the underlying GERD, as well as surgical options.
A category of drugs known as Proton Pump Inhibitors (PPIs) are the main tool used to significantly reduce stomach acid. Common ones include Prilosec (omeprazole), Prevacid (lansoprazole) and Nexium (esomeprazole) taken once or twice a day. Other acid reducing drugs, including Zantac, Pepcid and Tagamet, are available. Reglan (metoclopramide) is a drug that can strengthen the LES, which helps reduce the reflux (splashing up) of acid into the esophagus.
Some patients with GERD may need surgery to strengthen the LES. This is called fundoplication and is generally performed laparoscopically. Using surgical instruments inserted into several small incisions, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so the lower portion of the esophagus passes through a small tunnel of stomach muscle. This procedure strengthens LES, which is the valve between the esophagus and stomach. The helps to prevent acid from refluxing up into the esophagus as easily, which enables the esophagus to heal.
If you have a hiatal hernia, it will also be repaired with this procedure.
If cancer is found, surgery to remove the lower esophagus is usually necessary. Your physician may also recommend surgical removal of the lower part of the esophagus if high grade dysplasia is present to prevent it from occurring.
A diagnosis of Barrett’s esophagus requires regular monitoring by a physician. While it is thought that controlling GERD reduces the risk of developing cancer, this has not been definitively proven. Therefore, your doctor must perform regular endoscopy exams (EGD) and biopsies to look for dysplasia.