Barrett’s Esophagus is a condition that can occur in patients with gastro-esophageal reflux disease or GERD. It affects 1-2% of the adult population in the United States.
About Barrett’s Esophagus
Barrett’s Esophagus is a condition that can occur in patients with gastro-esophageal reflux disease or GERD. The cells of the esophagus are not designed to be exposed to chronic acid and other stomach contents. With Barrett’s esophagus, the inner lining of the esophagus evolves to become more like stomach or intestinal cells that are better equipped to handle the acidic environment. During an endoscopy, it appears as salmon colored tissue. Barrett’s esophagus can be considered a premalignant condition that predisposes patients to esophageal adenocarcinoma, although the risk is low. Patients with Barrett’s esophagus should have surveillance endoscopy every 3-5 years.
Any person that has a long history of acid reflux symptoms should be screened for Barrett’s esophagus. Unfortunately, Barrett’s esophagus is fairly under diagnosed because of lack of screening. Unfortunately, there is no consensus guidelines on when people should undergo a screening endoscopy like there is with colonoscopies. Once a patient is identified as having Barrett’s they are then placed in a surveillance program.
The present understanding is that Barrett’s esophagus has several steps before it develops into esophageal adenocarcinoma, these changes are called dysplasia. With regular Barrett’s esophagus without dysplasia, the cells are still normal looking intestinal cells that have normal architecture. With dysplasia, the Barrett’s cells start to appear abnormal and no longer look similar to one another. These changes can be classified as low-grade up to high-grade, each increasing the risk of developing esophageal adenocarcinoma.
Treating Barrett’s Esophagus
In addition to thoroughly evaluating your medical history and symptoms, our team of experts may conduct an endoscopy to determine if you have Barrett’s esophagus. In an endoscopy, your provider will insert a scope into your esophagus to assess the tissue lining the esophagus.
Here at UTHA, we have several different technologies that we use to test for Barrett’s Esophagus. Typical testing occurs at time of endoscopy; the endoscopist will examine the lining of the esophagus and take forceps biopsies of any areas of concern. In our practice, we also use a technology called optical endomicroscopy. This is similar to a small microscope that can look at the esophageal lining at a cellular level, basically allowing for real time pathology. This allows for fast and real time diagnosis of Barrett’s esophagus. Additionally, we use brush biopsies that allow for a wider and deeper area of tissue sample. This allows for more accurate and increased cellular change detection. By utilizing these advanced technologies, we can increase the chance of detecting Barrett’s esophagus 2-4 times that over normal tissue biopsies alone. We are the only group that utilizes this unique combination of advanced technologies in Central Texas.
Barrett’s esophagus without dysplasia is usually monitored with an upper endoscopy and biopsies every 3-5 years to ensure there is no progression to dysplasia or even cancer. Typically no treatment is necessary for Barrett’s esophagus, other than controlling acid exposure to the esophagus, which can be done by medication or potentially with anti-reflux surgery. Once dysplasia occurs, this is typically treated with radiofrequency ablation (RFA). RFA is minimally invasive and works by using heat to ablate the lining of the esophagus to eradicate the abnormal cells. This treatment significantly decreases the risk of progression to cancer.
Care Team Approach
Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, takes a multidisciplinary approach to your care. This means you will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include gastroenterologists, surgical and non-surgical heartburn and esophageal disorders specialists, physician assistants, nurses, advanced practice providers, dietitians, social workers, and more, providing unparalleled care for patients every step of the way. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with your other healthcare providers to ensure that we are providing you with comprehensive, whole-person care.