Barrett’s Esophagus

>>Barrett’s Esophagus
Barrett’s Esophagus 2017-04-30T22:14:42-07:00

A metaplasia or an abnormal change of cells, which constitutes the lower part of the oesophagus is known as the Barrett’s Esophagus. Technically, Barrett’s Esophagus is a ramification of cellular damage at the oesophagal level which is caused by a persistent exposure to the stomach acid. A recurring gastroesophageal reflux disease (GERD) is one of the leading reasons for this condition. In the worst case scenario, Barrett’s Esophagus can also turn into oesophagal cancer.

Causes of Barrett’s Oesophagus

Despite several types of studies, the precise cause of Barrett’s Esophagus has managed to escape medical sciences so far. However, it has been established that victims of GERD have a higher risk of catching Barrett’s Esophagus. In the event of GERD, the oesophagal muscles at the bottom are malfunctioning. This is what disables the sphincter from preventing the entry of food back into the oesophagus. Extended exposure to stomach acid has been identified as an underlying cause of Barrett’s Esophagus. While the instances of Barrett’s Esophagus are numerous without the prevalence of GERD, it is a widely accepted idea that GERD aggravates the condition and increases the risk by 3 to 5 times in the patients. Barrett’s Esophagus has almost double the morbidity in men as compared to the women. The diagnosis is usually made after 55 years of age. The cells of Barrett’s Esophagus have a natural tendency to turn into pre-cancerous cells and eventually, the cancerous cells. It has been estimated that around 0.5 % of the victims are at a risk of developing cancer at a later stage.

Risk Factors of Barrett’s Oesophagus

As mentioned earlier, if an individual has been experiencing the symptoms of GERD for more than ten years, the risk of Barrett’s Esophagus in such a patient is reasonably higher. A few of the other accentuated risk factors of Barrett’s oesophagus include the following:

  • Smoking or being obese
  • Being male and an age of above 50
  • Being a victim of H Pylori Gastritis
  • Being Caucasian

Since GERD has been established as an underlying cause for Barrett’s Esophagus, factors which may contribute in the aggravation of GERD are also the risk factors of Barrett’s Esophagus. A few of them include:

  • Smoking and alcohol consumption
  • Excessive use of Aspirins or NSAIDS
  • An unhygienic diet with an excess of saturated fats
  • Frequent consumption of spicy food or otherwise overeating in general
  • Lying down or worse, going to bed right after having a meal

Symptoms of Barrett’s Oesophagus

Unfortunately, Barrett’s Esophagus doesn’t have precise symptoms which pinpoint the condition. However, owing to the fact that majority of the patients are also a victim of GERD, frequent instances of heartburn have been reported by the patients. As a general principle, it is recommended to immediately consult your doctor if you are experiencing the following symptoms:

  • Frequent chest pain
  • Frequent vomiting that is either similar to the coffee grounds or else, vomiting blood
  • Having difficulty in swallowing the food or even fluids
  • Passing bloody stools which are black or tarry in appearance

Treatment of Barrett’s Oesophagus

There are varies options for treatment of Barrett’s Esophagus which are determined by your doctor after evaluation of the extent of dysplasia.

No or Minor Dysplasia:

Provided that you are fortunate enough to have a non-existent or minor grade dysplasia, your doctor will recommend a few medications which will primarily be focused at antagonising the GERD symptoms. H-2 receptor antagonists and the proton pump inhibitors are two of the commonest drugs used in such patients.

The alternative option of surgery is also at your disposal to address the symptoms of GERD permanently.

Two of the common surgical treatments for such patients include the following:

  1. Nissen Fundoplication
  2. LINX

Nissen Fundoplication:

This treatment is primarily focused on the strengthening of lower oesophagal sphincter (LES). Outside of the lower oesophagal sphincter is wrapped around the top portion of the stomach during this treatment.

LINX:

During this treatment, LINX device is inserted through the oesophagus by your doctor. The metal beads of LINX device serve the purpose of establishing magnetic attraction to prevent the leakage of stomach contents back into the oesophagus.

Stretta Procedure:

The Stretta procedure is carried out with the help of an endoscope. Radio waves serve the purpose of causing a muscular change near the junction of oesophagus and stomach. By strengthening the muscles, this treatment helps to prevent the reflux of stomach contents back into the oesophagus.

Major Dysplasia:

In the event of major dysplasia, more invasive procedures will be recommended by your doctor. The use of endoscopy, for instance, is common in such circumstances for the purpose of removing the portion of the oesophagus that has been affected. In worse situations, entire part(s) of the oesophagus may have to be removed. Other treatment options (at your disposal) include the following:

 Radiofrequency Ablation:

Radiofrequency ablation makes use of an endoscope that is associated with an attachment that produces heat. The heat is primarily focused on the abnormal cells to kill them.

Cryotherapy:

Cryotherapy makes use of a dispensed gas or liquid via an endoscope that essentially freezes the malfunctioning cells. Once thawed, the cells are frozen again, and the procedure is continued until all the abnormal cells are dead.

Photodynamic Therapy:

As the name suggests, this treatment involves a light-sensitive chemical which is commonly referred to as the Photofrin or Porfimer. It is injected into the patient’s body. After 24 to 72 hours of injection, endoscopy follows, which essentially activates the chemical with the use of a laser. The activated chemical helps in killing the malfunctioning cells.

Complications of Treatment Options

All of the treatments are to be carried out with extreme caution and precision since there are various complications associated with them. This is why it is recommended to get follow-up appointments after the treatment to ensure monitoring of the oesophagal lining. This will better equip your doctor to address the complications at very early stages.