This site is dedicated to the discussion of an important medical condition known as Barrett’s esophagus (BE). Generally speaking, the only people that seem to know about Barrett’s are those who have the condition. The truth is anyone suffering from chronic reflux or GERD is at risk for this silent pre-cancerous condition.
Esophageal cancer or adenocarcinoma of the esophagus is one of the fastest growing cancers in the United States and is directly associated with Barrett’s esophagus. Unfortunately, esophageal cancer is rarely detected in early stages and can lead to significant morbidity and mortality. It is clearly a condition to be prevented if at all possible.
It is estimated that up to 20% of the US population suffers from heartburn symptoms and that several million Americans have Barrett’s. Barrett’s esophagus results from a series of molecular mutations in the lining of the lower esophagus caused by acid reflux. Acid, pepsin and bile contained within reflux causes damage to the cells lining the esophagus. Injury, inflammation and repair leads to scarring and in some individuals, Barrett’s esophagus. BE seems to be more resistant to the damaging effects of acid injury and may be the body’s attempt to adapt to reflux. Surprisingly, Barrett’s esophagus produces no noticeable symptoms, and quite the opposite, often results in an improvement in heartburn complaints. Ironically, a patient whose heartburn has unexpectedly improved may have developed Barrett’s.
Individuals with heartburn should understand their need for appropriate medical screening. A common procedure known as "upper endoscopy" or "EGD" is used to directly examine the esophageal lining and is the only way to diagnose this condition. The discovery of Barrett’s esophagus is actually a fairly routine occurrence. While most patients are shocked when informed they have Barrett’s esophagus, they are certainly not alone.
So, why this website? Barrett’s esophagus is a tricky disease. It has a low overall risk of becoming cancerous , on the other hand, it is the main risk factor for esophageal cancer - which is on the rise. So what should the average person do? To add to everyone’s frustration…even the doctors are not in agreement on the best way to manage this condition. Individuals with Barrett’s really must do their own homework by getting multiple opinions, researching medical articles, and following the news. Our goal with this site is to help you with that process by providing a solid review on Barrett’s and also provide a forum for discussion for new developments, as they arise.
To begin, you need to get a little perspective on Barrett’s. Remember, most individuals with this condition will not develop cancer of the esophagus. So take a deep breath and relax. The next point, you need to find out some details about your case. Ask your doctor two important questions 1) how long is the Barrett’s segment and 2) was dysplasia present on the pathology report and how severe. These are probably the two most important risk factors to predict future development of cancer. We will discus these factors in more detail later, but the general idea is patients with large amounts (long segment) of Barrett’s with presence of severe dysplasia are at high risk for cancer and patients with a short segment and no dysplasia are at much lower risk of a cancer.
Lifestyle and environmental factors may also contribute to esophageal cancer risk. Some of these risk factors can be reduced with appropriate measures such as weight loss, exercise, proper diet, and possibly vitamin supplements. Controlling chronic heartburn / GERD (gastro esophageal reflux disease) is also very important since it is the primary cause of Barrett’s esophagus. Uncontrolled reflux may result in higher cancer risk. What are the dangers of anti acids? We will discuss the issues later on , as well.
Finally, It is also important for you to know there are different strategies in managing Barrett’s esophagus. A more traditional approach, also known as "endoscopic surveillance" relies on periodic check ups with upper endoscopy and taking biopsies of the esophageal lining. In this surveillance or traditional approach to Barrett’s, treatment (surgery) is only recommended after cancerous changes appear within the Barrett’s. However, an alternative to the traditional approach is the "early treatment" strategy and involves removal of the abnormal Barrett’s lining before cancerous changes have occurred. There are new techniques such as "endoscopic ablation" ( cryoablation and radiofrequency ablation)and endoscopic surgery (EMR) which provide an interesting option well suited for patients uncomfortable with the idea of "following" their Barrett’s. Although endoscopic ablation is a relatively new technology, early reports from doctors and patients have been very encouraging. News reports and media attention are thankfully raising awareness of Barrett’s and new technologies to treat this condition should continue to improve in their effectiveness.
Be prepared for conflicting medical opinions regarding Barrett’s management. Many physicians will argue for the more established "traditional" approach to Barrett’s and oppose early treatment, while others feel just as strongly about early removal of Barrett’s with endoscopic ablation. In the end, the decision is yours and should be based on a good understanding of the advantages and disadvantages associated with each strategy.
In summary, we hope this site helps provide much needed information as you research Barrett’s esophagus. We plan to post new topics for discussion in the Discussion Forum. Feel free to communicate and share experiences in this area or in the Community Room. We have provided some video and photos to this site to help with your education and will plan to have a section for interesting cases from our patients.
Finally, this site is only a resource, it is not meant to replace the advice of your own doctor. Always review any medical information found on this site with your personal physician.
Best of Health
William D. Lyday, MD