Barrett’s Esophagus

Barrett's esophagus is a condition that can develop in patients who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus). Muscles connecting the esophagus to the stomach work to keep food and fluids in the stomach from backing into the esophagus. When this fluid does back up, reflux, commonly known as heartburn, will occur. Some patients remain asymptomatic of heartburn or chest pain even in the presence of severe reflux disease. The lack of heartburn or chest pain does not mean you do not have reflux disease.

Prolonged exposure to reflux causes esophageal cells to change into cells that resemble those of the intestine. Over time, these changes can lead to the development of precancerous cells, which is referred to as high-grade dysplasia (HGD). It is important to know that most patients with Barrett’s esophagus do not develop HGD. However, it is crucial for patients with Barrett’s esophagus to be carefully monitored, since development of HGD significantly increases the risk of developing esophageal cancer. Approximately 45 percent of patients diagnosed with HGD have undiagnosed adenocarcinoma of the esophagus.

The Division of Thoracic Surgery at Brigham and Women’s Hospital (BWH) provides specialized services for Barrett’s esophagus, such as diagnostic endoscopy, photodynamic therapy with Photofrin™, endomucosal resection therapy (EMR), and other surgical options. Our board-certified surgeons are experts in the latest minimally invasive thoracic surgical techniques, including Nissen fundoplication and trans-oral therapies.

Barrett’s Esophagus Topics

Risk Factors for Barrett’s Esophagus

Factors contributing to an increased risk of developing Barrett’s esophagus include:

  • Prolonged reflux disease
  • White
  • Male
  • Over 50
  • History of cigarette smoking
  • Obesity
  • Onset of reflux disease at a young age
Symptoms of Barrett’s Esophagus

Many patients with Barrett’s esophagus experience no symptoms. Patients who do have symptoms may experience:

  • Frequent heartburn
  • Waking in the night due to heartburn or cough
  • Difficulty swallowing food
  • Vomiting
  • Blood in vomit or stool
  • Chest pain
  • Upper abdominal pain
  • Chronic, dry cough
  • Laryngitis or voice changes
  • Nausea
Diagnosis of Barrett’s Esophagus

In addition to a careful physical examination, your thoracic surgeon will perform the following tests or procedures:

  • Endoscopy, an endoscope is inserted through the mouth and into the esophagus, allowing the surgeon to see the lining of the esophagus and remove a tissue sample (biopsy), which is examined in a laboratory to determine whether the normal squamous cells have been replaced with precancerous cells.
  • Barium Swallow/Upper GI study involves X-ray pictures of your esophagus and stomach after you have swallowed a small amount of contrast material. If a patient complains of trouble swallowing, a barium swallow may be helpful in identifying areas of narrowing called strictures.
Treatment for Barrett’s Esophagus

Currently, there is no cure for Barrett's esophagus. Treatment is aimed at preventing further damage to the esophagus by stopping acid reflux from the stomach. Treatment may include:

  • Regular screening of your esophagus to check for high grade dysplasia
  • Medications such as H2 receptor antagonists and proton pump inhibitors, which reduce the amount of acid produced in the stomach
  • Lifestyle changes, including:
    • Avoid fatty foods, chocolate, spicy foods and peppermint
    • Avoid alcohol, caffeine, and tobacco
    • Lose weight
    • Sleep with your head elevated
    • Don’t lie down for 3 hours after eating
    • Take all medication with plenty of water
  • Minimally Invasive Procedures
    • Cryotherapy, a cold temperature treatment used to destroy diseased tissue
    • Photodynamic therapy with Photofrin™, a procedure using a combination of a laser and the drug Photofrin ™.
    • Endoscopic mucosal resection uses an endoscope to remove early stage cancer and eliminate Barrett’s mucosa.
    • Dilation procedure is used when strictures (narrowing of the esophagus) caused when the damaged lining of the esophagus becomes thick and hardened are present. During dilation, an instrument gently stretches the strictures and expands the opening of the esophagus.
  • Minimally Invasive Surgery
    • Surgery may be considered for patients with Barrett’s esophagus or for symptomatic disease. We recommend Nissen fundoplication surgery, in which part of the stomach is wrapped around the lower esophagus to prevent further damage from reflux. This procedure may in some cases reverse early Barretts esophagitis. Waiting to see if the HGD will turn into cancer is risky and often results in more advanced disease and a poorer prognosis by the time of surgery.
    • In patients who have developed dysplasia or very early cancer, endoscopic mucosal resection (EMR) can be used to remove early stage cancer.
    • If the area is too large, we offer a minimally invasive esophageal resection and reconstruction (esophagectomy), which can be achieved with minimally invasive surgery. Part of the diseased esophagus is removed and the remaining section is attached to the stomach.
What You Should Expect

You will receive a thorough diagnostic evaluation and receive clinically proven treatment by a board-certified thoracic surgeon who specializes in Barrett’s esophagus. Careful monitoring and the involvement of an experienced thoracic surgeon are important to the successful outcome for patients with Barrett’s esophagus and HGD.

Multidisciplinary care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your thoracic surgeon discovers an underlying illness or concern, you will be referred to an appropriate BWH physician for an expert evaluation.

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