About Barrett’s Esophagus
After swallowing, liquids and solid foods travel from the mouth to the stomach through a tube-shaped organ called the esophagus. The inside surface of the normal esophagus is covered by a pearly-white lining made up by cells similar to those that cover the skin. These cells are called squamous cells. In Barrett's esophagus (also called Barrett's metaplasia), the normal pearly-white lining is replaced by a pink-red velvety lining made up by cells called specialized columnar cells. They look like the cells that line the inner surface of the colon and include a very characteristic cell type called a "goblet cell”.
Patients who have Barrett's esophagus are at a greater risk for developing esophageal cancer ulcers and narrowing of the esophagus, which can cause trouble swallowing . Barrett’s esophagus related cancer has been affecting more and more people every year. It is one of the the fastest rising cancers in the United States. Most patients with this cancer have not been evaluated for Barrett’s esophagus earlier in their life.
Barrett's esophagus is estimated to affect about 700,000 adults in the U.S. Individuals with symptoms of GERD (for example, heartburn, acid regurgitation, sour taste in the mouth) are at an increased risk of developing Barrett's esophagus. Individuals older than 50, especially Caucasian men, are at high risk. Barrett's esophagus also occurs in Caucasian women, and in African Americans and Hispanics. Other groups at risk include obese individuals, those with a large waist circumference, smokers, and anyone with a family history of reflux or esophageal cancer.
Approximately 80 percent of patients with esophageal cancer removed by surgery when the cancer is discovered at an early stage live for at least five years. Unfortunately, in most cases, cancer is discovered at a late stage, and of these patients less than 25 percent survive three years after surgery. It is important, therefore, to be able to detect this cancer when it is still at an early stage. Best survival can be expected when the cancer is still in the lining of the esophagus. Once the cancer gets into the deeper muscle layer of the esophagus, chances of long-term survival are greatly diminished. This is the reason why it is important that patients with Barrett's be examined by an expert gastroenterologist with the proper tools, at regular time intervals (endoscopic surveillance).
Treatment options for Barrett's esophagus depend on several factors including the presence or absence of hiatal hernia, extent of Barrett's metaplasia, presence and severity of pre-cancerous tissue, as well as overall health of the patient.
These options, all available at Baylor Medicine include dietary modifications, medications to suppress stomach acid secretion, local ablation therapies such as radio frequency ablation and cryoablation, and endoscopic mucosal resection.
In patients with early stage cancers, endoscopic removal via endoscopic submucosal dissection (ESD) may be performed. This technique, performed through a standard endoscope via the mouth, allows removal of all cancerous tissue, without incisions or removal of the esophagus.