What is Barrett’s Esophagus?
Barrett’s esophagus occurs when the esophageal lining near the area where the esophagus and stomach meet is modified.
It is a pathology that affects the esophageal mucosa, due to the uncontrolled reflux of stomach acids it receives, replacing the normal squamous cells of the esophagus with abnormal epithelial cells, which represents a risk that can evolve into dysplasia.
Barrett’s esophagus is one of the risk factors directly related to esophageal adenocarcinoma. The risk of esophageal cancer is clearly related to the degree of dysplasia.
What is dysplasia?
Dysplasia is an abnormal epithelium in which the cells are disorganized, which has a significant risk of progressing to esophageal cancer if not properly treated.
Although cancer does not have to occur in most patients with Barrett’s esophagus, this precancerous tissue modification may occur in some patients.
Dysplasia can only be diagnosed by examining tissue samples taken by biopsy. These tissue samples are categorized as “high grade”, “low grade” or “undefined for dysplasia”.
In high-grade dysplasia there are abnormal modifications in many cells with an abnormal growth profile. Low grade dysplasia indicates that some abnormal modifications are found in the tissue sample but do not include most of the cells and the cell growth profile is still normal. “Undefined for dysplasia” means that it cannot be verified whether or not the tissue modifications are caused by dysplasia. Some alterations, such as inflammation of the esophageal lining, can make the cells appear to be dysplastic when they may not be.
If dysplasia is confirmed, the specialist will determine the most advisable treatment option depending on the progression of the dysplasia and the patient’s general health.
Causes of Barrett’s Esophagus
One of the main causes of Barrett’s Esophagus is the chronic inflammation caused by Gastroesophageal Reflux Disease (GERD).
Gastroesophageal Reflux Disease affects up to 20% of the population and occurs when there is reflux of gastric contents into the esophagus, causing bothersome symptoms in the patient.
It is important to take into account the symptoms of GERD, the most prominent being heartburn or restrosternal burning, although sometimes some patients report atypical symptoms such as hiccups, nausea, chest pain, or even dry cough, laryngitis, or pharyngeal irritation.
Incidence of Barrett’s Esophagus
Barrett’s esophagus is more common in patients who have had Gastroesophageal Reflux Disease(GERD) for many years and generally occurs more in men than in women.
Although not all patients with heartburn may have Barrett’s esophagus, it is advisable to perform a gastroscopy in patients who have had significant heartburn or who have required the use of medications to control it for several years.
Symptoms of Barrett’s esophagus
The importance of early diagnosis and treatment of this disease lies in its potential progression to esophageal adenocarcinoma.
The symptoms they present are:
- Frequent and long-lasting heartburn.
- Difficulty swallowing (dysphagia).
- Bloody regurgitation (hematemesis).
- Retrosternal pain, at the point where the stomach and esophagus join.
- Weight loss due to difficulty in eating.
Diagnosis: How is Barrett’s Esophagus diagnosed?
The diagnosis of this pathology is made by gastroscopy and the detection of changes in esophageal tissue can be confirmed by biopsy.
The Digestive System specialist performs a study of the esophagus by means of an upper endoscopy (gastroscopy), to see if there are sufficient tissue changes to indicate Barrett’s Esophagus. This examination includes observation of the esophagus, stomach and duodenum. In case the specialist suspects Barrett’s esophagus, tissue samples (biopsy) are taken to make a definitive diagnosis.
Capsule endoscopy is another procedure that can diagnose Barrett’s esophagus, although in this test, the physician cannot take a tissue sample (biopsy).
Both techniques make it possible to observe the end of the esophagus and determine whether the normal lining of the walls has been modified, but gastroscopy is mainly recommended since it is the one that allows biopsies to be performed to confirm the diagnosis with certainty.
Treatment: How is Barrett’s Esophagus treated?
Radiofrequency Ablation
There are several treatments that can eradicate the tissue that causes Barrett’s Esophagus. Radiofrequency ablation is currently considered the treatment of choice in cases of Barrett’s esophagus associated with dysplasia, given its efficacy and safety.
It involves the application of radiofrequency energy by means of bipolar electrodes, causing rapid heating of the treated tissue to an established and reproducible depth. This procedure is generally performed on an outpatient basis and requires only deep sedation. In addition, the incidence of recurrence after treatment with Radiofrequency Endoscopic Ablation is much lower than with other ablation techniques.
The implementation of this technique has been preceded by multiple studies that endorse its encouraging results.
One of the main advantages of endoscopic treatment in patients with superficial adenocarcinoma is the low rate of complications compared to the treatment that until now was considered standard: esophagectomy (removal of the affected portion of the esophagus by surgery).
Recommendations on Barrett’s Esophagus
Although the risk of a patient with Barrett’s esophagus having esophageal cancer is quite low, it is advisable to practice periodic endoscopic examinations.
