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. 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 changes to a stomach or intestinal cell that is 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 at UT Health Austin
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.
About the Heartburn and Esophageal Disorders Center
The UT Health Austin Heartburn and Esophageal Disorders Center has assembled a team of experts that includes a gastroenterologist, surgeons, and associate providers, imaging experts, a dietitian and social workers. This team enables us to provide the right care for the right patient at the right time. For some patients, nonsurgical interventions such as lifestyle modifications and medications can help improve symptoms of reflux, while surgery may be the best course of action for others. Whatever your needs, our team is here to listen and work with you to develop a treatment plan that is right for you.