Barrett’s Esophagus

February 1, 2017

Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that carries food and liquids from the mouth to the stomach—is replaced by tissue that is similar to the intestinal lining. The condition is recognized as a complication of gastroesophageal reflux disease. Its importance lies in its predisposition to evolve into esophageal cancer.

The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Its inner lining, or mucosa, normally consists of flat cells (known as squamous cells) that are similar to those of the skin. This condition where the squamous cell lining is replaced by other cells that have a more cube-like shape, is known as Barrett’s esophagus or the columnar-lined esophagus, referring to cells that are shaped like a column. When Barrett’s esophagus is present, the columnar lining extends from the junction of the esophagus and stomach upwards into the esophagus for a variable distance ranging from a few millimeters to nearly the entire length of the esophagus.

When the normal squamous lining cells of the esophagus are replaced by columnar cells, the process is known as metaplasia. Barrett’s esophagus is a form of metaplasia. The metaplastic columnar lining comes in three types. Two types are similar to groups of cells found in regions of the stomach lining. The third type is similar to groups of cells found in the small intestine. This intestinal type of metaplasia is important because it can potentially lead to the development of cancer.

Barrett’s esophagus occurs more often in men than women. People who have had GERD for a long time are more likely to have this condition.

Causes

The exact reasons for the development of Barrett’s esophagus are unknown. The most widely accepted theory is that damage to the squamous mucosa initiates a process of healing. There are cells lying deep in the wall of the esophagus that have the potential to transform themselves into a variety of shapes and take on special functions during this healing process. It is these cells that become the new columnar mucosa of the esophagus. Most physicians believe that the damage to the squamous mucosa which leads to the development of Barrett’s esophagus is caused by chronic reflux of acid or other stomach contents into the esophagus. It is likely that some people are predisposed to develop Barrett’s esophagus based on their genetic make-up.

Who is at risk?

There are a number of risk factors for the development of Barrett’s esophagus, including:

  • Symptoms of GERD
  • Obesity
  • Increasing age
  • Caucasian ethnicity
  • Male gender
  • Family history of Barrett’s esophagus

Symptoms

Barrett’s esophagus usually doesn’t produce any specific symptoms on its own. People with chronic acid reflux problems may experience a variety of symptoms including heartburn, regurgitation of food, swallowing difficulties, excess belching, hoarseness, sore throat, cough, or breathing problems similar to asthma such as shortness of breath and wheezing. The columnar lining may become irritated and bleed, resulting in anemia (low blood count), or may develop ulcerations which cause pain, but these problems aren’t common. Barrett’s oesophagus is suspected when there are symptoms of persistent gastric reflux or symptoms of complicated reflux. These symptoms include –

  • Persistent heartburn
  • Difficulty swallowing
  • Painful swallowing
  • Vomiting
  • Weight loss
  • A sensation of fullness during eating

Treatment

Medications – A certain category of drugs called proton pump inhibitors are the main tool used to markedly reduce stomach acid. There are a number of these medications available. Some of the more common ones include Prilosec (omeprazole), Prevacid (lansoprazole), AcipHex (rabeprazole), Protonix (pantoprazole) and Nexium (esomeprazole) taken once or twice a day. All of these are equally effective despite some deceptive advertising. Other acid reducing drugs such as Zantac, Pepcid, Axid, and Tagamet are also available.

Photodynamic therapy (PDT) uses a special laser device, called an esophageal balloon, along with a drug called Photofrin.

Other procedures use different types of high energy to destroy the precancerous tissue.

Surgery removes the abnormal lining.

Alternative Treatment

Multi-Vitamins – Daily supplements of multi vitamins containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Probiotic supplement – Probiotics or “friendly” bacteria may help maintain a balance in the digestive system between good and harmful bacteria. Some probiotic supplements may need to be refrigerated for best results.

Omega-3 fatty acids, such as fish oil, may help decrease inflammation in case of acid reflux.

DGL-licorice helps protect against stomach damage. Glycyrrhizin is a chemical found in licorice that causes side effects and drug interactions. DGL is deglycyrrhizinated licorice, or licorice with the glycyrrhizin removed.

Lifestyle Changes – Barrett’s Esophagus can be cured simply by the elimination of foods, beverages and habits that increase the risk of acid exposure to the esophagus. Common health risks include tobacco and alcohol use, but Barrett’s Esophagus is also cured by reducing the amount of spicy, refined or processed foods in the diet, along with avoiding soft drinks and aspirin. Losing weight is also beneficial; excess weight puts additional pressure on the abdomen and pushes up the stomach, causing acid to back up in the esophagus.

Reference –

http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/barretts-esophagus/Pages/definition-facts.aspx

http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/esophagus_stomach/barretts_esophagus.pdf

http://www.asge.org/patients/patients.aspx?id=8954

http://www.aboutgerd.org/site/what-is-gerd/barretts/

http://www.sts.org/patient-information/esophageal-surgery/barretts-esophagus

http://www.healthline.com/health/barretts-esophagus#Overview1

http://www.gihealthcare.com/alternative-treatment-for-barretts-esophagus-condition-results-from-chronic-acid-reflux/

http://www.collectivewizdom.com/BarrettsEsophagus-CausesandTop10NaturalRemedies.html

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