Barrett’s esophagus is a condition where the lining of the esophagus is affected. It occurs in the context of long-term, untreated gastroesophageal reflux disease (GERD). Over time, the chronic irritation caused by acid reflux leads to the transformation of the esophagus’s squamous epithelium into intestinal epithelium. Barrett’s esophagus affects up to 2% of the Western population and can serve as a precursor to esophageal cancer.
Symptoms:
People with Barrett’s esophagus may not experience any symptoms. However, symptoms such as heartburn, difficulty swallowing, nausea, chest pain, or upper abdominal pain may indicate the need for further investigation.
Risk Factors for Barrett’s Esophagus:
• Obesity
• Smoking
• Age over 50
• Fair skin type
• Family medical history
• Male gender
Disease Progression and Stages:
There are three stages of Barrett’s esophagus, ranging from intestinal metaplasia without dysplasia to high-grade dysplasia. Dysplasia refers to abnormal cell growth in the tissue. Dysplasia is not classified as cancer but can increase the risk of developing cancer.
Epidemiological studies show that patients with Barrett’s esophagus have a 30-125 times greater chance of developing esophageal adenocarcinoma compared to individuals without Barrett’s.
• Intestinal Metaplasia without Dysplasia: Barrett’s esophagus is present without visible precancerous cellular changes in the esophageal lining.
• Low-Grade Dysplasia: The cells show early precancerous changes that could lead to esophageal cancer.
• High-Grade Dysplasia: The cells of the esophagus exhibit high levels of precancerous changes, believed to be the final stage before esophageal cancer.
Management:
Patients with Barrett’s esophagus without cellular dysplasia remain under surveillance with endoscopic check-ups at regular intervals (e.g., every 1 to 3 years) to detect and treat any potential development of dysplasia or early cancer.
Barrett’s esophagus can nowadays be treated in its early stages either by endoscopic removal of the affected esophageal epithelium or by the HALO method. This technique involves cauterizing the Barrett’s epithelium during endoscopy, leaving the submucosal layer intact and capable of regenerating normal epithelial tissue. The treatment lasts about one hour, is well tolerated by the patient, and has excellent results with no significant complications. After the endoscopic treatment, regular follow-up is required, initially more frequently (every 3 or 6 months during the first year), with intervals increasing over time.
Pharmacological treatment with drugs that inhibit stomach acid should be discussed with the physician regarding duration and dosage.
