What is Barrett’s esophagus?
The esophagus is the tube that connects the mouth to the stomach. Barrett’s esophagus forms when the normal esophageal lining is replaced by intestinal tissue, a process called intestinal metaplasia. This usually occurs as a consequence of gastroesophageal reflux disease (GERD).
What is GERD?
Gastroesophageal Reflux Disease (GERD) occurs when acid and other stomach contents flow backward from the stomach into the esophagus with abnormal frequency, often eroding or ulcerating the normal lining of the esophagus.
How does Barrett’s form?
Barrett’s is a defense mechanism, mediated by the body’s own stem cells. Damage in the body is repaired by stem cells as they have the ability to change to any type of cell to repair damage. The normal esophageal lining is not very tolerant of acid. When it is eroded away in certain individuals, stem cells attempt to protect the esophagus by turning into intestinal cells that are more tolerant of the refluxing acid. Genetic changes in the cells are needed to make this change, and it is the accumulation of certain genetic changes over time which seems to predispose these Barrett cells to cancer.
What is the risk of cancer in Barrett’s esophagus?
On average, a person with Barrett’s esophagus seems to have an approximate 8% risk of developing esophageal adenocarcinoma over one’s lifetime. While this risk may seem high, most patients with Barrett’s are more likely to die from factors other than esophageal cancer. Each individuals risk may be different and may depend on a variety of factors, including race, gender, family history, degree of involvement, age and duration of disease. White males seem to be at particular risk. Many factors are poorly understood. For instance, Barrett’s patient’s in Ireland with the earliest form of Barrett’s seem to have a risk of cancer developing at 0.3% per year, while the incidence reported from England is as high as 1% per year. The most widely accepted figure in the U.S is 0.5% per year for the earliest stages, suggesting that over 10 years there is a 5% risk. The later stages which involve “dysplasia” have significantly higher risk. Which patients are most likely to progress from the earliest stages is unclear. However, since these cells are now intestinal cells, the cancer that may occur is adenocarcinoma, or intestinal-like cancer. This is typically harder to treat than the cancer that develops in more normal esophageal cells (ie.: squamous cell carcinoma). Additionally, unlike the rest of the intestine, the esophagus is surrounded by lymphatic ducts that are close to the surface. Thus, cancer cells may penetrate these ducts and pass to other tissues (metastasize) quite early. This has resulted in a rather dismal 8-15% five year survival for patients with invasive adenocarcinoma of the esophagus. Comparatively, the five year survivals in similar staged colon cancer are 66-90%. Thus, early diagnosis and possible treatment may be helpful.
How is Barrett’s esophagus diagnosed?
Currently, upper endoscopy is the best way to diagnose Barrett’s. Your gastroenterologist collects small pieces of tissue from the lining of the esophagus. The pathologist performs special stains to determine if these cells have changed to intestinal-like cells. Additional analysis may help to access the risk of cancer. A variety of techniques may be used to help the endoscopist and pathologist assess risk.
How is Barrett’s treated?
Although most precancerous conditions are treated by removing the pre-cancer and decreasing the risk, we have not had a safe or effective means to remove Barrett’s tissue until recently. We have traditionally followed Barrett’s patients with periodic surveillance endoscopy to check for advancing disease. While this seems appropriate in certain circumstances, there has been no consensus amongst our societies and teaching institutions as there has been little or no data to support the safety of surveillance guidelines. Most authorities agree that aggressive suppression of acid is imperative in protecting the esophagus and helping to decrease the risk of dysplasia and cancer for all stages of Barrett’s esophagus in selected patients. During the last decade, several physicians of Florida Digestive Health Specialists have helped to perfect the technique of Radiofrequency Ablation of Barrett’s (RFA). There are now over 60 peer-reviewed papers supporting the safety, efficacy and cost effectiveness of RFA for all stages of Barrett’s esophagus in selected patients.This data has helped establish new guidelines for treating and managing Barrett’s patients, and continues to evolve. The physicians of Florida Digestive Health Specialists have contributed and continue to participate in some of the most ground breaking clinical research in this field.
What is Radiofrequency Ablation?
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