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Barrett's Esophagus

Definition:
Barrett's esophagus is a complication of chronic esophagitis, which is inflammation of the esophagus.

Barrett's esophagus is characterized by a change in the cells lining the esophagus. Normal cells are flat-shaped (squamous) cells, while Barrett's esophagus cells are shaped like a column. This cell change is called metaplasia. It is a premalignant phase that may eventually result in cancer of the esophagus.

Causes:
The exact cause of Barrett's esophagus is unknown. However, it may result from damage to the esophagus caused by the chronic reflux of stomach acid. Frequent or chronic reflux of stomach acid into the esophagus is called gastroesophageal reflux disease, or GERD.

Risk Factors:
A risk factor is something that increases your chances of getting a disease or condition.

  • Chronic heartburn
  • History of GERD
  • Age: 50 and over
  • Sex: Male
Symptoms:
Although Barrett's esophagus does not directly produce symptoms, people with GERD may experience the following:
  • Heartburn
  • Chest pain
  • Nausea or vomiting
  • Blood in vomit or stool
  • Sore throat or chronic cough
  • Hoarse voice
  • Sour taste in mouth (acid reflux)
  • Shortness of breath or wheezing
  • Difficulty swallowing (dysphagia)
Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:
  • Endoscopy – a thin, lighted tube inserted down the throat to examine the esophagus
  • Biopsy – removal of a sample of tissue from the esophagus during the endoscopy to be tested for cancer cells
Treatment:
Once the cell changes of Barrett's esophagus occur, the changes are permanent. The goal of treatment is to prevent further damage by stopping the reflux of acid from the stomach. Treatment may include:

Medications
The following types of medications may be prescribed:
  • H2 blockers, such as:
    • Cimetidine
    • Ranitidine
    • Famotidine
    • Nizatidine
  • Proton pump inhibitors, such as:
    • Omeprazole
    • Lansoprazole
    • Pantoprazole
    • Rabeprazole
Surgery
If the disease is severe or the medication is unsuccessful, your doctor may recommend surgery. Surgical options may include:
  • Fundoplication – part of the upper stomach is wrapped around the esophagus; this is done to reduce further damage caused by GERD
  • Esophagectomy – removal of the Barrett's segment of the esophagus
Monitoring
Your doctor may recommend endoscopy about (or at least) every 1-3 years to monitor the esophagus for early signs of cancer. This recommendation must be individualized for each person.

Prevention:
The best way to prevent Barrett's esophagus is to minimize and/or treat the reflux of stomach acid into the esophagus, which is usually due to GERD. In addition to drugs or surgery, self-care measures for GERD include:
  • Don't smoke. If you smoke, quit.
  • If you are overweight, lose weight.
  • Elevate the head of your bed on 4-6 inch blocks.
  • Avoid clothes with tight belts or waistbands.
  • Avoid foods that cause heartburn. These include alcohol, caffeinated beverages, chocolate, and foods that are fatty, spicy, or acidic (such as citrus or tomatoes).
  • Eat 4-6 small meals per day.
  • Do not eat or drink for 3-4 hours before you lie down or go to bed.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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