Barrett's esophagus is when the cells lining the esophagus - the tube that connects the mouth and the stomach - change to resemble the lining of the stomach, due to damage from acid reflux. This condition can potentially increase the risk of developing esophageal cancer in the future.
The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.
An abnormal, backwards flow of fluid within the body.
Barrett's esophagus occurs when the lining of the esophagus, which is sensitive to stomach acid, becomes chronically irritated due to repeated exposure to this harsh acid. Stomach acids travel into the esophagus if there is heartburn, otherwise known as gastro-esophageal reflux disease (GORD). The lining of the esophagus, which normally has pinkish, flat cells (squamous cells) to allow the easy passage of food, change with chronic exposure to stomach acids, into red, tall cells (columnar cells, also known as columnar epithelium) that secrete acid-repellent mucus, much like the lining of the stomach. This change in cell structure is known as metaplasia, and this defines Barrett's esophagus. It commonly occurs at the lower portion of the esophagus, where exposure to stomach acid is greatest; however, occasionally it can occur higher up.
In certain cases, with ongoing exposure to stomach acids, the cells continue to change to become cancerous, i.e. esophageal cancers. While the majority of people with Barrett's esophagus will not develop esophageal cancer, the potential is always there and the number of cases is increasing.
A healthy esophagus compared with Barrett's esophagus.
The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.
A thick, viscous liquid that is secreted for lubrication and to form a protective lining over certain tissues.
An abnormal, backwards flow of fluid within the body.
Risk factors for Barrett's esophagus include:
A type of fat produced by the body that is necessary for metabolism.
An abnormal, backwards flow of fluid within the body.
A fat or lipid that is composed of one glycerol molecule and three fatty acid molecules. Triglycerides are the most common fat in the blood and levels that are too high can increase the risk of conditions such as diabetes and heart disease.
The state of high glucose level in the blood during periods of fasting, but which is not high enough to be classed as diabetes. Also known as pre-diabetes.
The hallmark of Barrett's esophagus is metaplasia, where squamous cells of the esophagus change into columnar cells. The columnar cells resemble stomach or intestinal lining cells, which may offer some protection from acid reflux. However, with ongoing exposure to stomach acids, these cells can become abnormal, known as dysplasia. Dysplasia is a precancerous stage, which can progress to cancer or alternatively recover if risk factors are removed.
In low-grade dysplasia, the architecture of the Barrett's cells become more distorted. The cells appear larger and their pattern abnormal and irregular.
In high-grade dysplasia, the cellular disorganization is even greater. The cells appear large and multi-layered. The risk of developing esophageal cancer from this grade is quite high.
Progression from a healthy esophagus to Barrett's esophagus.
The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.
Precancerous cells that are distinguished from cancer cells by lacking the ability to invade other tissues or spread to other parts of the body.
An abnormal, backwards flow of fluid within the body.
Barrett's esophagus does not produce any symptoms; rather, symptoms are caused by acid reflux from the stomach, as part of heartburn. These include:
Sometimes acid reflux has no symptoms, so metaplasia can be occurring silently. This can make Barrett's esophagus difficult to diagnose.
An abnormal, backwards flow of fluid within the body.
During a gastroscopy procedure, you'll be sedated and a long, thin and flexible tube (endoscope) will be carefully fed down to the esophagus. Imaging of the area will be carried out via a light and a small camera attached to the tube. Barrett's esophagus tissue can appear pink or red compared to the usual pale-colored esophageal lining. Gastroscopy can be used to take a biopsy of any suspicious-looking areas for further diagnosis.
A biopsy is a tissue sample taken for microscopic examination by a pathologist in the laboratory to check for cancer and other diseases. For Barrett's esophagus, the biopsy is taken during a gastroscopy and the pathologist will then determine if any cellular changes are present and check to make sure any of the abnormalities are not cancerous.
Ambulatory pH monitoring involves a very thin wire being threaded through your nose and into your esophagus. It is attached to a small recording device that determines the acid levels in the lower esophagus. Because symptoms can be minimal or non-existent in Barrett's esophagus, the pH monitoring can help with diagnosing silent acid reflux and the effects of medications on reducing acid levels in the esophagus.
A doctor specializing in the microscopic study of disease, such as examining a tissue sample taken in a biopsy.
A measure of how acidic or basic a solution is.
An abnormal, backwards flow of fluid within the body.
A test that involves inserting a flexible scope down the throat to view the internal lining of the esophagus (the feeding pipe), stomach and beginning of the intestines.
Barrett's metaplasia and low-grade dysplasia is often treated with lifestyle changes, antireflux medications and follow-up gastroscopy. High-grade dysplasia can be treated with a number of gastroscopic or surgical options.
Reducing acid reflux into the esophagus can help prevent or reduce the progression of Barrett's esophagus. Acid reflux can be less severe if you avoid caffeine, alcohol, peppermint and spicy foods. Stopping smoking and reducing your weight if overweight or obese can also reduce acid reflux. Elevating the head of your bed with bricks can help to reduce acid reflux when lying down.
Medications, such as proton pump inhibitors and/or histamine-2 blockers, which can decrease the amount of stomach acid produced, can be used to control symptoms, promote healing and reduce the risk of progression to dysplasia and esophageal cancer.
Endoscopic therapy with endoscopic mucosal resection or radiofrequency ablation can be used in some cases of high-grade dysplasia. This is usually reserved for cases where the dysplasia has not spread into deeper layers of the esophagus and there has been no spread to lymph nodes.
Endoscopic mucosal resection is performed during an endoscopy. An instrument called a snare is used to remove the affected esophageal tissue.
Radiofrequency ablation and cryotherapy can be used in conjunction with endoscopic mucosal resection to destroy the remaining abnormal cells.
Cryotherapy uses liquid nitrogen or carbon dioxide to destroy cells.
Photodynamic therapy uses chemical agents called photosensitizers and a laser light to destroy abnormal cells.
This is surgery to remove all or part of the esophagus. It is generally reserved for extensive high-grade dysplasia or a confirmed cancer. If a cancer extends into the stomach, part of the stomach is removed, along with part of the esophagus (oesophago-gastrectomy). The whole esophagus might need to be removed (total esophagectomy), in which case it may be replaced with part of the bowel.
The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.
Precancerous cells that are distinguished from cancer cells by lacking the ability to invade other tissues or spread to other parts of the body.
Medications that inhibit or reduce the activity of proton pumps (proteins that move protons, or hydrogen atoms, across cell membranes in the body). These medications can be used to reduce the production of gastric acid in order to treat peptic ulcers and heartburn.
The use of radio waves as a heat source to kill cancer cells.
An abnormal, backwards flow of fluid within the body.
A test that involves inserting a flexible scope down the throat to view the internal lining of the esophagus (the feeding pipe), stomach and beginning of the intestines.
One of the most common complications from treatment is stricture formation, which is the narrowing (stenosis) and tightening of the esophagus due to scarring. The more of the esophagus that has been subjected to treatment, the greater the risk of stenosis. Bleeding can occur from esophageal endoscopic procedures and also from surgery. In some cases, bleeding can be severe due to the high density of blood vessels in the esophagus. Nausea and mild discomfort can result from radiofrequency ablation. Pain-relief medication is usually required.
Barrett's esophagus can progress to esophageal cancer. The type of cancer it causes is known as an adenocarcinoma.
The use of radio waves as a heat source to kill cancer cells.
If caught before it progresses to cancer, treatment for Barrett's esophagus has a very good prognosis. However, esophageal cancer has a poor prognosis.
The progress of Barrett's esophagus can be reduced by limiting acid reflux into the esophagus. Unfortunately, in some cases the acid reflux may not produce symptoms, so prevention may not be possible if the condition goes undiagnosed. You can reduce your risk by maintaining a healthy body weight, not smoking, avoiding foods and substances that worsen acid reflux and by taking medication if recommended by your doctor to lessen the damage caused by stomach acid.
An abnormal, backwards flow of fluid within the body.