What Is 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 "goblet cell."
What Causes Barrett's Esophagus?
It is caused by repeated episodes of acid reflex, known as gastroesophageal reflux disease (GERD). Normally the juices of the stomach do not go back into the esophagus. However, in some people this can occur, and because the normal cells which line the inner surface of the esophagus are not resistant to the stomach juices, they get inflamed, causing these individuals to have a "heart burn."
Why Should I Care About Barrett's Esophagus?
Patients who have Barrett's esophagus are at a greater risk for developing cancer of the esophagus, ulcers in the esophagus, narrowing of the esophagus tube so they will have problem swallowing the food, and most importantly cancer. Patients who have Barrett's esophagus have increased odds (risk) for getting a special type cancer in the esophagus than people who do not have Barrett's esophagus. This type of cancer is called "adenocarcinoma." This type of cancer has been affecting more and more people every year. It is the fastest rising cancer in white Caucasian men in the United States. Most patients with this cancer die within two years of diagnosis, but survival for as long as 10 years (and even cure) can be achieved if the cancer is discovered in its early stage, and removed by surgery.
Who Is at Risk of Developing Barrett's Esophagus?
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. Others groups at risk include obese individuals, those with a large waist circumference, smokers, and anyone with a family history of reflux or esophageal cancer.
What Happens if I Have Barrett's Esophagus?
Approximately 80 percent of patients with esophageal adenocarcinoma removed by surgery when the cancer is discovered at an early stage live for at least five years. Unfortunately, in most patients 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 muscle 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 a specialized doctor, a gastroenterologist, at regular time intervals (endoscopic surveillance) so if they get cancer it can be removed early to increase their chances of living longer.