What is Barret's Esophagus?
Barrett’s esophagus is a condition that occurs in the lower part of the esophagus called the esophagus. Normally, the esophagus opens and closes under the control of a muscle called the lower esophageal sphincter, which connects to the stomach, preventing acidic contents from the stomach from escaping back into the esophagus. But in some cases, the work of this muscle may be impaired, and the acidic contents in the stomach may escape back into the esophagus. When this back-escape continues for a long time, the lining of the esophagus can be damaged, a condition called Barrett’s esophagus. Barrett’s esophagus is a condition that increases the risk of developing cancer in the esophagus and therefore requires regular follow-up and treatment.
What are the causes of Barret's Esophagus?
Barret’s esophagus is a condition that occurs as a result of changes in some cells of normal esophageal tissue such as stomach tissue. This change occurs as a result of damage to the esophagus due to long-term stomach acid reflux.
Stomach acid reflux is the reflux of stomach contents into the esophagus. Normally, a muscle called the lower esophageal sphincter, which is a muscle barrier, separates the stomach from the esophagus. In some cases, however, this muscle may be weak or loose, and stomach contents may flow back.
Stomach acid can damage esophageal tissue, and cells can change as a result of long-term damage. As a result of this change, normal esophageal cells turn into cells that cause the formation of Barret’s esophagus.
Other risk factors for Barret’s esophagus include obesity, smoking, consuming high-fat foods, consuming alcohol, and having a family history of Barret’s esophagus.
How is Barret's Esophagus diagnosed?
Barret’s esophagus can be diagnosed as a result of a series of tests and imaging studies performed by a gastroenterologist. To make a diagnosis, the following can be done:
- Endoscopy: This test is a procedure performed by inserting a device called an endoscope into the esophagus. The endoscope shows changes in the inner surface of the esophagus. The diagnosis of Barret’s esophagus can be confirmed by a biopsy specimen taken during this test.
- Biopsy: Samples taken during endoscopy are examined in the pathology laboratory. Biopsy specimens are used to determine whether the cells in the esophageal tissue are normal or typical cells of Barret’s esophagus.
- Isotope scanning: Isotope scanning is used to measure the level of acid reflux inside the esophagus. In this test, a drink containing a radioactive substance is drunk and then a scanning device placed in the esophagus is used to count the number of times the stomach contents flow back upwards.
- Manometry: This test is used to determine how tight or loose the lower esophageal sphincter muscle is. In this test, a device is inserted into the esophagus and the pressure level inside the esophagus is measured.
- pH measurement: This test is done to measure the level of acid in the esophagus through a device placed in the esophagus. In this test, a device is inserted into the esophagus and the acid level in the esophagus is recorded for 24 hours.
The results of these tests are evaluated by a gastroenterologist and a diagnosis of Barret’s esophagus is made or denied.
How Is Barret's Esophagus Treated?
The aim of Barrett’s esophagus treatment is to control acid reflux in the esophagus and prevent the progression of damage to the esophagus. In addition, regular follow-up is recommended to reduce the risk of developing cancer. The methods used in the treatment of Barrett’s esophagus are:
- Drug treatment: Acid-suppressing drugs can be used to control acid reflux. These medications reduce stomach acid, preventing the progression of damage to the esophagus. In some cases, prokinetic drugs may also be used. These drugs increase the functioning of the muscles in the lower part of the esophagus, allowing the acidic fluid in the esophagus to move towards the stomach.
- Surgical treatment: In rare cases, drug therapy may not be sufficient and surgical treatment may be required. Surgical treatment options include a procedure called Nissen fundoplication to strengthen the muscles in the lower part of the esophagus, or placing a device in the lower part of the esophagus (LINX device).
- Endoscopic treatment: Endoscopic treatment methods include endoscopic ablation to repair damage to the esophagus, endoscopic resection to remove the abnormality in the esophagus, and balloon dilatation to open the narrowing of the esophagus.