What is Barrett’s esophagitis and how is it treated?
Barrett's esophagitis, also called Barrett’s
esophagus, is an irritation in the lining of the esophagus caused by chronic
reflux of the contents from the stomach and small intestine into the esophagus.
There are a number of risk factors for the development of Barrett's esophagus,
including:
- Early onset of reflux symptoms
- Long duration of reflux symptoms
- Reflux symptoms at night
Patients at greatest risk of developing Barrett's are Caucasian males over
age 50 who have a history of chronic heartburn.
The symptoms of Barrett's esophagus are similar to the symptoms of
gastroesophageal reflux disease (GERD). These include a burning sensation under
the chest and acid regurgitation. These symptoms generally decrease with
medications that reduce acid in the stomach.
Some people with Barrett’s may also have difficulty swallowing. This
symptom requires immediate medical attention.
The only way to confirm the diagnosis of Barrett's esophagus is with a test
called an upper endoscopy. This involves inserting a small lighted tube (endoscope)
through the throat and into the esophagus to look for a change in the lining of
the esophagus. While the appearance of the esophagus may suggest Barrett's
esophagus, the diagnosis can only be confirmed with small samples of tissue
(biopsies) obtained through the endoscope.
The treatment of Barrett's esophagus is similar to the treatment of
GERD. This includes lifestyle changes, such as
avoiding certain foods, not eating late in the evening, stopping smoking, and
wearing loose-fitting clothing, along with using medications that will decrease
acid production by the stomach.
Patients with Barrett's esophagus typically need prescription medications to
reduce acid, such as omeprazole (Prilosec), lansoprazole (Prevacid),
pantoprafile (Protonix), rabeprazole (Aciphex), or esomeprazole (Nexium). These
medications are typically taken before breakfast once a day or, on occasion,
before breakfast and dinner. Over-the-counter medications known as H2 receptor
antagonists (Tagamet, Zantac, Axid, and Pepcid) are generally not as effective
in decreasing the acid damage to the esophagus that causes Barrett's esophagus,
but may relieve symptoms for some patients.
Barrett's esophagus is a premalignant condition that may lead to the
development of cancer of the esophagus in some patients. The risk of developing
cancer is approximately 1% each year.
Esophageal cancer develops through a sequence of changes in the cells of the
esophagus known as dysplasia. Dysplasia can only be detected by endoscopic
biopsies. Patients with Barrett's esophagus should have regular screening exams
to detect cancer at an early and potentially curable stage.
Studies are in progress to develop a more effective treatment for Barrett's
esophagus. One treatment, known as ablation therapy, damages the lining of the
esophagus with heat or laser light. This causes normal cells to develop because
of a decrease in acid production. This type of therapy holds great promise for
the future, although it is still in the testing phase. Other new treatments are
also under development.