Barrett’s esophagus presents risks but treatments available

John M. Haydek

Barrett’s esophagus is a condition where the cells lining the lower portion of the esophagus change from a sturdy and strong type, like our skin, to an acid-resistant type found commonly in the intestines, a shift called intestinal metaplasia. The condition is believed to be caused by an excess regurgitation of acid and stomach contents into the esophagus over a time period of several years.

Barrett’s esophagus also can be a precancerous condition that requires follow-up care over time. It falls into types based on the amount of abnormal tissue present in the esophagus. Here are several questions commonly asked about Barrett’s esophagus.

Can Barrett’s esophagus occur in all people with acid reflux?
The condition is usually seen in white males over the age of 50 who smoke and have extra tissue around the middle portion of their abdomen called central obesity. This is a group targeted by screening strategies. In reality, Barrett’s esophagus can occur in any patient if the conditions are right. You should always discuss the risks with your physician.

If I don’t feel reflux, can I still get Barrett’s esophagus?
Since acid regurgitation is seen as the cause of Barrett’s esophagus, the majority of patients have some signs of reflux such as burning in the chest (heartburn), regurgitation of gastric contents or difficulty swallowing. There is some evidence that patients with the condition lose sensation in the lower esophagus over time, which suggests that not all patients feel active reflux all the time. Therefore, the risk of Barrett’s esophagus is determined by more than just the recurrence of heartburn.

How common is esophageal cancer in patients with Barrett’s esophagus?
The risk of developing esophageal cancer in someone with Barrett’s esophagus is scary if we compare the risk to someone without Barrett’s. In reality, the risk of esophageal cancer is very low if we compare risks of all patients with Barrett’s. In general, the longer the segment of Barrett’s – the segment refers to the tissue measurement – the higher the risk of cancer. Medical literature suggests that in patients with Barrett’s esophagus, there is a .12% risk of esophageal cancer yearly, or 1 in 860, most of which occur in those with long-segment Barrett’s.

Is there treatment available for Barrett’s-related cancer if it is found?
Yes! Advances in the past decade have greatly expanded our ability to treat and cure Barrett’s and early esophageal cancer using techniques like endoscopic mucosal resection (EMR), radiofrequency ablation (RFA) or cryotherapy.

Knoxville is fortunate to have a nationally known center of excellence in Barrett’s esophagus treatment at the Thompson Cancer Survival Center. I am the medical director of the Center of Excellence for Treatment of Barrett’s Esophagus, and we welcome inquires and the opportunity to discuss treatment options with patients.