Barrett's esophagus is a rare condition in which the lining of the esophagus is replaced by intestinal-type tissue. Barrett's esophagus is thought to be caused by gastroesophageal reflux (GERD) and can be a precursor to esophageal cancer. Barrett's esophagus has no symptoms and is therefore difficult to diagnose. Since it occurs more often in patients already diagnosed with GERD, physicians recommend that certain individuals who have been diagnosed with GERD undergo an esophagogastroduodenoscopy (EGD) to screen for Barrett's esophagus.
Barrett's esophagus can only be diagnosed by endoscopy. Even though the disease itself has no symptoms, about 1% of patients with Barrett's esophagus develop a dangerous form of esophageal cancer called adenocarcinoma. For this reason, individuals with Barrett's esophagus should be monitored for dysplasia (an abnormal change in cells that can be a precursor to cancer) through endoscopy and tissue biopsies.
If dysplasia is detected, it can be destroyed using surgery or endoscopic procedures. One treatment for Barrett's esophagus is called photodynamic therapy (PDT). This therapy uses a chemical called Photofrin, which makes tissue more sensitive to light. Fourty-eight hours after Photofrin is given to the patient, a physician can pass a laser tube (via an endoscope) into the esophagus and destroy the abnormal Barrett's tissue.
Barrx, another method of destroying high-grade dysplasia, may be used in patients who are not candidates for surgery.
Another treatment for dysplasia in Barrett's esophagus is called endoscopic mucosal resection (EMR). EMR can be used for Barrett's esophagus or for esophageal cancer. In this procedure, a substance is injected beneath the lining of the Barrett's tissue before it is removed via endoscope. If the treatment is used for esophageal cancer, only the top layer of cells will be removed. Because of this, it can only be used for severe dysplasia or very early stage cancer.
For individuals who have severe dysplasia or overt cancer and are healthy enough to undergo general anesthesia, surgery remains the first choice therapy for Barrett's esophagus with high-grade dysplasia or cancer. Several surgical procedures are used depending on a patient's individual needs and the location of the tumor.
Although Barrett's esophagus is a fairly rare disorder and there is a very small chance of developing esophageal cancer from it, adenocarcinoma of the esophagus has a relatively poor overall prognosis when diagnosed in an advanced stage. For this reason, it is important that individuals suffering from GERD are aware of the disease and seek appropriate medical care.
National Digestive Disease Clearing House. Barrett's Esophagus. Accessed: July 21, 2009 from http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/