by Kimberly Allen, RN
Barrett’s esophagus is a condition that affects the lower portion of your esophagus, near the stomach. Barrett’s esophagus is classified as a short-segment, which is less than 3cm, and long-segment, which is greater than 3cm, disease depending on how much of the esophagus is affected. Experts estimate that short-segment Barrett’s esophagus occurs in approximately 15% of Americans while long-segment Barrett’s esophagus affects only approximately 0.5% of Americans. In the US, Barrett’s esophagus is 8 times more common in white men than white women. White men are also 5 times more likely to develop Barrett’s esophagus than African American men.
In Barrett’s esophagus, the lining of the area affected becomes damaged. When the esophagus attempts to repair itself the cells sometimes change. When examined, the lining of the esophagus affected cells that are normally found in the lining of the stomach and/or intestines have replaced esophageal cells. It’s the intestinal cells known as goblet cells that determines whether or not you have Barrett’s esophagus. Goblet cells are basic columnar epithelial cells. Their only function is to secrete a protein called mucin which converts water to mucous. Experts believe the reason the cells change is because the cells that are meant to be in that area are not strong enough to be able to tolerate the change in the environment so they are replaced with cells that are better able to tolerate the changed environment.
Though the precise cause of Barrett’s esophagus is not known, Doctors do know that the majority of people with Barrett’s esophagus also suffer from GERD or gastroesophageal reflux disease. In GERD, the content of the stomach push backwards up into the esophagus. It is believed that it is the change in acidity that damages the epithelial cells lining that area of the esophagus. Then when the esophagus goes to repair itself it needs stronger cells to be able to tolerate the new more acid environment.
A person with Barrett’s esophagus will usually complain of symptoms that are related to GERD including frequent heartburn and difficulty swallowing food. Some people may also complain of upper abdominal pain ore even chest pain and some may even have a dry cough. Though many people with Barrett’s esophagus have symptoms of GERD, not all people with Barrett’s esophagus have symptoms or their symptoms are mild. In fact, there are some people in which Barrett’s esophagus is discovered accidentally during an exam for something else or a routine endoscopic examination.
The reason doctors are concerned about Barrett’s esophagus is that it is associated with an increased potential for a certain type of esophageal cancer called adenocarcinoma. Adenocarcinoma develops in the “new” cells that are intestinal cells that have replaced the normal epithelial cells. As the incidence of Barrett’s esophagus has increased in the Western world so has the incidence of adenocarcinoma.
The most important component of treatment for Barrett’s esophagus is to control the acid reflux. The good news is if you control the acid reflux and the environment in the esophagus returns to normal the cells lining the esophagus will return to normal. So how do you control the acid reflux? Most doctors recommend a combination of lifesyle changes and medication. Lifestyle changes would include changing your diet so that it contains less fatty and/or spicy foods as well as caffeine and chocolate. If you are over weight it’s important to lose weight. Limiting or avoiding alcohol and tobacco will also improve acid reflux. It’s also recommended that you don’t lie down for at least 3 hours after eating and elevate the head of your bed slightly when sleeping. There are also a variety of medications available that can reduce the acid reflux as well as neutralize the acids in the stomach. Some are available over the counter while others require a prescription, your doctor can help you decide what will work best for you.