Barrett's Esophagus Last updated: Sep 22, 2008

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  Barrett's Esophagus  
 

 
Conditions that suggest it | It can lead to... | Recommendations

 
 

The esophagus is a muscular tube that carries food from the mouth to the stomach. The stomach makes acid, which participates in the digestion of food. There is a valve between the esophagus and stomach that normally prevents acid and other stomach contents from being refluxed back into the esophagus. However, many people in the United States have a weak valve, and acid can reflux back onto the lining of the esophagus eventually resulting in Barrett's esophagus. .
Normally, the esophagus is lined by a white tissue that is similar to the skin on the forearm, whereas the stomach is lined by a red, mucus-secreting tissue that is resistant to acid. When acid is refluxed onto the white lining of the esophagus, it can cause pain, which can be felt as heartburn or indigestion. If the acid reflux is not treated effectively, it can cause damage to the white lining of the esophagus.

After enough damage, the normal white esophageal lining can become replaced with a red lining that is called "Barrett's esophagus". This red lining secretes mucus and is therefore more resistant to acid than the normal white lining. However, the red lining of Barrett's esophagus is abnormal and differs from the normal red lining of the stomach. In a minority of patients (approximately 5-10%), a subpopulation of cells within the red lining (Barrett's esophagus) can progress to become a cancer.

The premalignant lining of Barrett's esophagus can be seen at endoscopy and diagnosed by endoscopic biopsy. Therefore, it is recommended that patients who have chronic heartburn or indigestion undergo endoscopy with biopsy to determine whether or not they have developed Barrett's esophagus.

Barrett's esophagus had no cure, short of surgical removal of the esophagus, which is a serious operation, until the use of the HALO360 Ablation System (see in treatment section). Most physicians have recommended treating GERD with acid-blocking drugs, since this is sometimes associated with improvement in the extent of the Barrett's tissue. However, this approach has not been proven to reduce the risk of cancer. Treating reflux with a surgical procedure for GERD also does not seem to cure Barrett's esophagus.

 
 

Conditions that suggest Barrett's Esophagus:
 
 
Digestion  Heartburn / GERD
 Barrett's esophagus usually doesn't produce any specific symptoms on its own, but 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.
 
 

Barrett's Esophagus can lead to:
 
 
Risks  Increased Risk of Esophageal Cancer
 For unknown reasons, the incidence of cancers arising in Barrett's esophagus (defined as the number of cancers per 100,000 people in the general population) is increasing more rapidly than that of any other cancer in the United States. Unfortunately, most of these cancers are not detected until they have become so large that they are incurable. However, cancers in Barrett's esophagus that are detected when they are early and of small size, have a cure rate that is improved dramatically.

If Barrett's esophagus is diagnosed, regular follow-up endoscopic biopsy evaluations are recommended for the early detection of changes that could lead to cancer. Surgery is the only therapy that has been proven to cure early adenocarcinoma arising in Barrett's esophagus. Therefore, if an early cancer is detected in endoscopic biopsies, surgery is generally recommended to remove the cancer and the premalignant Barrett's epithelium.
 
 

Recommendations for Barrett's Esophagus:
 
 
Electrical  Electrical Devices
 BARRX Medical, Inc. today announced that 70% of the patients enrolled in a multi-center clinical trial were free of a precancerous condition called Barrett's esophagus one year after treatment. The data was published in the February issue of Gastrointestinal Endoscopy, a medical journal for gastroenterologists who perform advanced endoscopic procedures. In the report titled, "Circumferential Endoscopic Ablation of Barrett Esophagus using a Balloon- Based System: One-Year Follow-up of 100 Patients," patients with Barrett's esophagus were safely treated with the HALO360 Ablation System.

"Publication of the one-year results of the AIM (Ablation of Intestinal Metaplasia) Trial represents a very important milestone in the advancement of this ablative technology for our patients with Barrett's esophagus," says Dr. Sharma. "Until now, the patient with Barrett's esophagus was relegated to a lifetime of frequent endoscopic surveillance procedures to watch for progression to more dangerous forms of the disease, like dysplasia and cancer. The results of this study suggest that we can safely and proactively eliminate Barrett's esophagus at the very earliest stage, rather than limiting ourselves to passive observation of the disease for progression. This has been a welcome change in the management strategy for our patients with Barrett's esophagus."

In this study, patients with the earliest stage of Barrett's esophagus (intestinal metaplasia) received ablation using the HALO360 Ablation System, a balloon-based radiofrequency device designed to remove the diseased cells using controlled heat.

The procedures were performed non-surgically, using endoscopy, which allowed the patient to return to normal activity after treatment. Follow-up visits over 12 months included frequent endoscopy with biopsy procedures to determine if the disease was fully eliminated. At one year, 70% of patients were cured of Barrett's, while the remaining patients had near-complete resolution of their disease.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Highly recommended







GLOSSARY

Asthma:  A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.

Biopsy:  Excision of tissue from a living being for diagnosis.

Cancer:  Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.

Chronic:  Usually Chronic illness: Illness extending over a long period of time.

Endoscopy:  A procedure that uses an Endoscope.

Esophagus:  Commonly called the "food pipe", it is a narrow muscular tube, about nine and a half inches long, that begins below the tongue and ends at the stomach. It consists of an outer layer of fibrous tissue, a middle layer containing smoother muscle, and an inner membrane, which contains numerous tiny glands. It has muscular sphincters at both its upper and lower ends. The upper sphincter relaxes to allow passage of swallowed food that is then propelled down the esophagus into the stomach by the wave-like peristaltic contractions of the esophageal muscles. There is no protective mucosal layer, so problems can arise when digestive acids reflux into the esophagus from the stomach.

Gastric Reflux Disease:  Gastro-Esophageal Reflux Disease (GERD). A common relapsing condition affecting approximately 10% of the U.S. population and caused by an abnormal exposure of the lower esophagus to refluxed gastric contents, causing irritation and injury to the esophageal tissues. GERD develops as a result of relaxations of the transient lower esophageal sphincter. Typical presenting symptoms are heartburn, an epigastric burning sensation and acid regurgitation. However, some patients may present with atypical symptoms such as chest pain, shortness of breath, wheezing, and coughing.

Stomach:  A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.