Barrett’s esophagus
For many of the 60 million Americans who suffer from heartburn or gastroesophageal reflux disease, symptoms of burning behind the chest bone and acid regurgitation are a regular occurrence. Over time, irritation to the esophagus can cause the normally white lining to be replaced by a precancerous red one, known as specialized intestinal metaplasia. The condition – Barrett’s esophagus – is being diagnosed in more and more patients and should be taken seriously, doctors say.
Henry Russell, M.D., medical director of the Heartburn Treatment Center of Middle Tennessee at Williamson Medical Center, estimates that 10 to 12 percent of patients with GERD also have Barrett’s esophagus, which has been linked to a form of cancer called esophageal adenocarcinoma.
“Though the cancer still is somewhat rare, the incidence definitely is on the rise, increasing fivefold in 30 years,” Russell says.
While the risk of developing cancer is seemingly low at half a percent a year for patients with Barrett’s esophagus, the disease often goes undetected until a person is in his or her 60s and the esophageal lining has been changing for 10 to 20 years.
According to Russell, identifying those at risk for GERD is an important first step in preventing the esophageal cancer, which kills 90 percent of those it affects.
“Because Barrett’s esophagus is an acquired disorder, those at risk are longstanding refluxers,” he says. “Many may have no or minimal symptoms. Warning signs including difficult or painful swallowing and other non-specific symptoms such as unexplained weight loss should mandate evaluation by a physician.
The American College of Gastroenterology cites additional risk factors for Barrett’s esophagus including age, being a white male and GERD symptoms of longer than 10 years.
Franklin gastroenterologist Bill Burch, M.D., says acid reflux is a primary reason for doctor visits in America. He says patients are becoming more educated about GERD, including potential health risks associated with the condition.
“Age and the length of time symptoms have occurred are the two main factors I consider when treating a patient with acid reflux,” Burch says. “Younger patients typically find relief through prescription medications. Those who have had reflux more than 10 years and are over age 40 should undergo endoscopy.”
In an endoscopy procedure, patients swallow a thin, flexible tube that transmits internal images to physicians, helping them make a diagnosis.
Once patients are diagnosed with the disease, they continue to be scoped every two to three years to look for changes that could increase the risk for esophageal cancer. During the procedure, Burch removes biopsies of the affected area every two centimeters.
“We’re looking for Barrett’s esophagus much more readily today than we did in the past,” he says. When found early, the disease can be treated with medication or surgery.
Russell says debate continues about which treatment is more effective for preventing development of the cancer. Advanced Barrett’s may require surgical removal of the esophagus. Other techniques such as photoablation and laser treatment remove the Barett’s lining and encourage regrowth of new, healthy cells. Burch says the disease has become an important area of discussion in the gastroenterology field, and investigational trials are under way to research new ways to treat the disease.
Causes of GERD
The cause of GERD can be traced to the esophagus, the muscular tube that carries food and liquid from the throat into the stomach. When a valve called the lower esophageal sphincter fails to remain tightly closed, acidic stomach fluids may come up, or reflux. The severity of GERD depends on how weak the sphincter is, and the amount and duration of acid refluxed into the esophagus. Unlike the lining of the stomach, which is equipped to handle high levels of acid, the lining of the esophagus is sensitive and easily inflamed.
In addition to heartburn, symptoms of acid reflux may include persistent sore throat, hoarseness, chronic cough, asthma, heart-like chest pain, difficulty swallowing or a feeling of a lump in the throat.
Left untreated, acid reflux can lead to Barrett’s esophagus, ulcers, scarring and narrowing of the esophagus and, in some cases, esophageal cancer. A primary care physician or gastroenterologist often can diagnose GERD by symptoms alone. Additional tests, however, may be needed to determine severity.
