Barrett esophagus

The exact underlying cause of Barrett esophagus is unknown. However, certain factors are known to increase the risk of developing the condition. These include:

• Long-standing gastroesophageal reflux disease (GERD)
• Obesity (specifically high levels of belly fat)
• Smoking

Factors that may decrease the risk include having a Helicobacter pylori (H. pylori) infection; frequent use of aspirin or other nonsteroidal anti-inflammatory drugs; and a diet high in fruits, vegetables, and certain vitamins.

Esophagogastroduodenoscopy (EGD) with a biopsy is the procedure of choice for confirming a diagnosis of Barret esophagus. A diagnosis is often made while investigating other conditions such as gastroesophageal reflux disease (GERD).

Based on the biopsy, a doctor will be able to determine the severity of the condition, which can help inform treatment decisions. The sample may be classified as:

• No dysplasia - a diagnosis of Barrett's esophagus is confirmed, but no precancerous changes are found in the cells
• Low-grade dysplasia - the cells show small signs of precancerous changes
• High-grade dysplasia - the cells show many precancerous changes. This is thought to be the final step before cells change into esophageal cancer

The National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK) Web site offers more specific information on the diagnosis of Barret esophagus. Please click on the link to access this resource.

Barrett esophagus usually occurs sporadically in people with no family history of the condition. In rare cases, it can affect more than one family member; however, it is unclear whether these cases are due to common environmental exposures or an inherited predisposition (or a combination of the two).

One study found that some people with Barrett esophagus who go on to develop esophageal adenocarcinoma have changes (mutations) in the MSR1, ASCC1, and/or CTHRC1 genes. However, additional studies are needed to confirm these findings.

People with Barrett esophagus are typically counseled to eat a diet that eases the signs and symptoms of gastroesophageal reflux disease (GERD), which can cause further damage to the esophagus. For example, it is often recommended that affected people avoid foods and beverages that may trigger their symptoms. For many people, these include:

• Caffeine
• Spicy, fried or fatty foods
• Chocolate
• Full-fat dairy products
• Peppermint
• Spearmint
• Alcohol
• Coffee
• Carbonated beverages
• Citrus fruits or juices
• Garlic
• Onion
• Tomatoes and tomato sauce
• Ketchup
• Mustard
• Vinegar
• Aspirin
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

People with Barrett esophagus may also need to decrease the size of portions at mealtime, avoid eating three hours prior to bedtime, and lose weight (if overweight).

The long-term outlook (prognosis) for people with Barrett esophagus is generally good. In many cases, treatment improves acid reflux symptoms and keeps Barrett esophagus from getting worse.

People with Barrett esophagus do have a greater risk than the general population of developing esophageal cancer. However, the overall risk is still low as less than 0.5 percent of people with Barrett esophagus develop cancer of the esophagus each year.

The treatment of Barrett esophagus largely depends on the severity of the condition as determined by the level of dysplasia seen on biopsy. In people with no dysplasia or low- grade dysplasia, treatment is often focused on easing the signs and symptoms of gastroesophageal reflux disease (GERD), which can cause further damage to the esophagus. This may include certain medications and lifestyle modifications such as avoiding smoking; eliminating food and drinks that trigger heartburn; raising the head of the bed while sleeping; and/or avoiding late night snacking. Periodic endoscopy may also be recommended to monitor Barrett esophagus as other treatments may be indicated if the condition advances.

Because high-grade dysplasia is thought to be the final step before cells change into esophageal cancer, more aggressive treatments are typically recommended. These may include:[

• Endoscopic resection - an endoscope is used to remove damaged cells
• Endoscopic ablative therapies - different techniques such as photodynamic therapy or radiofrequency ablation are used to destroy the dysplasia in the esophagus. In photodynamic therapy, abnormal cells are destroyed by making them sensitive to light, while radiofrequency ablation uses heat to remove abnormal esophagus tissue.
• Surgery - the damaged part of the esophagus is removed and the remaining portion is attached to the stomach

The National Institute of Diabetes and Digestive and Kidney Diseases' (NIDDK) Web site offers more specific information on the treatment and management of Barret esophagus. Please click on the link to access this resource.