Papafragkakis
Charilaos Papafragkakis, MD
Gastroenterologist - Hepatologist

Barrett Esophagus

Barrett's esophagus is a pathological change in the esophageal mucosa caused by chronic gastroesophageal reflux disease. It is a condition that is graded according to its severity. In advanced stages it is dangerous for cancer. Diagnosis is done by upper endoscopy and biopsies.

The risk of esophageal cancer in patients with advanced Barrett's esophagus is estimated to be 30-125 times that of the general population. Barrett's esophagus is estimated to be present in 1-2% of all patients who undergo gastroscopy for any cause and in 5 to 15% of patients with gastroesophageal reflux disease.

What are the symptoms of Barrett's esophagus?

Most patients have a long history of acid reflux. These patients complain of burning sensation in the chest, bitter taste in the mouth from acid regurgitation, difficulty in swallowing and persistent, unexplained cough or hoarseness. Unfortunately, some patients with Barrett's esophagus have very mild heartburn or no other symptoms.

How is the Barrett esophagus diagnosed?

Diagnosis requires gastroscopy. Small tissue samples are taken from the esophagus (biopsy). These samples are then sent to a pathologist for examination under the microscope. The pathologist looks for areas with dysplasia. Dysplasia is a pre-cancerous condition (not cancer). Dysplasia may develop from low grade to high grade, and maybe to cancer, but sometimes it can get better with treatment.

If the biopsy results determine that there is Barrett's esophagus with low grade dysplasia, you will need a repeat endoscopy in 6 months. If you continue to have low-grade dysplasia after 6 months, you will need close endoscopic follow up.

If you have Barrett's esophagus with high degree of dysplasia, the risk of cancer is greater. Normally, a follow-up gastroscopy should be done for patients with a high degree of dysplasia 6 weeks after the first endoscopy.

What are the treatment options for Barrett's esophagus?

Currently, there are no medicines to reverse the Barrett esophagus. However, if we deal successfully with the underlying acid reflux, we may slow the progression of the disease.

More specialized methods for treating Barrett's esophagus are:

  • Endoscopic Mucosal Resection (EMR) is the endoscopic removal of a portion of the affected mucosa
  • Endoscopic burning of areas of dysplasia (Radiofrequency ablation, RFA)
  • Surgical removal of the esophagus

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