Barrett's Esophagus – Overview, Causes, Symptoms, Treatments, Prognosis, and More
Overview
Barrett’s esophagus describes the transformation of your esophageal lining to a type of cells found in your intestines. In simple terms, if you take a part of your esophagus (i.e., food pipe), you will find cells that normally belong to the intestines.
This happens due to the chronic exposure of the esophagus to the acidity of the stomach. Normally, the lower esophageal sphincter (LES) shuts down any communication between the food pipe and the stomach. However, the loosening of this sphincter exposes the relatively sensitive cells of the esophagus to the low pH of the stomach.
Because of a concept known as homeostasis, which refers to the tendency of the body to always find balance, the esophageal cells will transform into a different type of cells that can handle this harsh environment.
Unfortunately, untreated Barrett’s esophagus can transform into esophageal cancer, leading to some serious complications.
In this article, we will cover everything there is to know about Barrett’s esophagus, including the role of acid reflux disease and how we can treat both conditions.
What causes Barrett’s esophagus?
While scientists still haven’t figured out the exact cause of Barrett’s esophagus, the vast majority of patients have gastroesophageal reflux disease (GERD).
When the muscles that make up the lower esophageal sphincter relax, gastric content will regurgitate into the esophagus. While some patients develop Barrett’s esophagus without GERD, those who have acid reflux are 5 times more likely to develop this condition.
According to reports, around 5%–13% of people with GERD will develop Barrett’s esophagus. The incidence of this disease is twice as high in men relative to women. Additionally, most cases get discovered by the age of 55 years and older.
If you have Barrett’s esophagus, it doesn’t mean you will inevitably get cancer. It just means that you are at a very high risk of the disease. Taking the proper measures will dramatically lower your risk.
In fact, only 0.5% of patients with Barrett’s esophagus will eventually develop esophageal cancer.
What are the risk factors?
Having GERD for more than a decade increases the risk of Barrett’s esophagus dramatically. However, it is still relative; remember that only 5% to 10% of GERD cases turn into Barrett’s esophagus.
Aside from GERD, other risk factors of Barrett’s esophagus include:
· Gender – Males are more likely to develop Barrett’s esophagus.
· Race – Caucasians are at a higher risk.
· Age – Most people get diagnosed after the age of 55.
· A medical history of gastric infections – Mainly gastritis caused by H. pylori
· Weight – Overweight and obese individuals are at a higher risk.
· Smoking
The same factors that worsen the symptoms of GERD can also exacerbate Barrett’s esophagus. Some of these factors are:
· Smoking
· Alcohol
· Frequent use of non-steroidal anti-inflammatory drugs (NSAIDs)
· Eating large portions at meals
· Diets high in saturated fats
· Spicy foods
· Lying down in bed shortly after eating your meal
It should be noted that many who have GERD also have laryngopharyngeal reflux (LPR) symptoms. We wrote about LPR here.
The signs and symptoms of Barrett’s esophagus
Barrett’s esophagus does not present with specific signs and symptoms. Because the vast majority of patients with this condition also have GERD, Barrett’s esophagus patients report experiencing symptoms of heartburn (more on that later).
With that said, if you develop any of the following symptoms, make sure to call your doctor immediately:
· Severe chest pain
· Dysphagia (i.e., difficulty swallowing)
· Hematemesis (i.e., vomiting blood)
· Melena (i.e., black or tarry stools)
Can you develop cancer from Barrett’s esophagus?
Barrett’s esophagus augments the chances of esophageal cancer. However, this cancer is relatively rare. Reports say that 10 out of 1,000 people with Barrett’s esophagus will develop cancer over the course of 10 years. If you have Barrett’s esophagus, your doctor will take your medical history and schedule regular checkups to monitor any signs of cancer. They may also order biopsies, which examine the esophageal tissues to look for any precancerous cells. If precancerous cells are present, we call this pathological state dysplasia.
Note that the early detection of cancer is crucial for your prognosis. Therefore, regular screening tests become indispensable for people with Barrett’s esophagus.
The diagnosis of Barrett’s esophagus
According to research, most cases of Barrett’s esophagus get diagnosed around the age of 55 years. When you visit your doctor with symptoms of heartburn, they will take your medical history, conduct a physical exam, and recommend an endoscopy.
The endoscopic procedure involves inserting a tiny, flexible tube with a high-quality camera and a source of light at the end. Using the endoscope, the doctor will inspect the lower portion of the esophagus, looking for any changes in the tissues.
If Barrett’s esophagus is suspected, your doctor may take a tissue sample. Next, the pathologist will inspect the sample under the microscope to identify any dysplasia.
Your doctor will schedule subsequent endoscopies following this timeline:
· After 12 months of your first procedure, you undergo another endoscopy. If no tissue changes are present, you repeat the endoscopy every 3 years.
· If you have mild tissue changes, you will undergo a procedure after 6–12 months.
Treatment options for Barrett’s esophagus
Depending on the stage of Barrett’s esophagus, the treatment will be different.
Low-grade dysplasia
This describes having a limited number of dysplastic cells. It may also mean you don’t have any dysplasia. In this case, your physician will recommend some lifestyle changes, along with conventional GERD medications. These include proton pump inhibitors and H2-receptor antagonists. If your GERD symptoms do not improve despite medical treatment, your doctor may suggest a few surgical options, including:
Nissen Fundoplication
The purpose of this procedure is to increase the tonicity of the lower esophageal sphincter. During this procedure, your surgeon will wrap the top of the stomach around the outer side of the LES.
LINX
Inserting the LINX device around the esophagus helps with your GERD symptoms. The LINX device consists of metal beads that get attracted to each other, preventing any leakage from the stomach to the esophagus.
TIF Procedure
TIF (Transoral Incisionless Fundoplication) is a newer procedure. This is an incision free fundoplication procedure where a device is inserted in the mouth and down to the LES where the esophagus is partially wrapped 270 to 300 degrees. Recovery times are shorter than compared to traditional Nissen fundoplication.
High-grade dysplasia Sodium alginate therapy for Barrett's Esophagus
High-grade dysplasia describes an extensive number of dysplastic cells. In this case, a more aggressive approach is better to prevent cancer. Some patients may need to undergo surgical removal of the affected tissues with the help of endoscopy. Others may need to remove entire sections of the esophagus.
Besides direct surgical interventions, other treatments may include:
Radiofrequency ablation
Using an endoscope, your doctor will expose the abnormal cells to a source of heat that eradicates them.
Cryotherapy
Also using an endoscope, your doctor will release cold gas to freeze the dysplastic cells. Once the cells thaw, your doctor will expose them once again to the cold. Repeating this process will kill the abnormal cells.
Photodynamic therapy
During this procedure, your doctor will inject you with porfimer, which is a light-sensitive chemical. Once you get the injection, you will undergo an endoscopy after 24 to 72 hours. Using a laser attached to the endoscope, the injected chemical will get activated and induce apoptosis (i.e., programmed cellular death) in the dysplastic cells.
Gastroesophageal reflux disease
To understand gastric reflux, we need to take a look at the anatomy of the upper digestive tract.
When you eat a meal, the food goes from the mouth to the stomach, passing through the esophagus aka the food pipe. Once the food reaches the stomach (acidic environment), it will remain there for a couple of minutes before continuing its path down the digestive tract.
To prevent acid from going up to the throat, the lower portion of the esophagus has a thick muscular structure known as the lower esophageal sphincter (LES), which contracts to block the backflow of acid.
Unfortunately, this system is not perfect; in some cases, the LES opens up when it should be closed, which leads to GERD.
In the vast majority of cases, GERD is a benign condition as long as the patient is not experiencing any other health problems.
While most people experience acid reflux occasionally, if you have symptoms at least twice a week, you might be dealing with GERD.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), GERD affects around 20% of Americans.
Note that untreated GERD could precipitate severe complications.
The treatment options for GERD
To relieve your symptoms of GERD, you need a holistic approach that takes into account your diet, exercise, pharmacological drugs, supplements, and general lifestyle changes. Eat more fiber and lower your intake of GERD-triggering foods, such as chocolate and alcohol. Exercise more often to improve your digestion and use two pillows when sleeping.
You will also need to take one of these medications:
· Antacids
· H2 receptor blockers
· Proton pump inhibitors
If these treatments fail to improve your condition, you may want to speak to a surgeon about your candidacy for the GERD procedures we listed above.
The under-discussed role of Alginate Rafts in treating GERD and Barrett’s esophagus
Sodium alginate therapy for Barrett's Esophagus is a rapidly growing area of interest. Raft-forming alginate creates a low-density viscous gel when it contacts the acidity of the stomach. This gel-like raft will sit on top of the acid pocket that usually forms after eating a meal, preventing the acidic content from leaking back to the esophagus.
The best part about alginate is its instant action. The second you take alginate and bicarbonate together, the raft quickly forms and helps prevent reflux. Note that consistently taking alginate products will help prevent future reflex, but they are not a medication and cannot stop existing reflux. They are not antacids in the traditional sense of the word. If acid from the stomach is already up into the esophagus, the alginate raft can’t do anything about that. However, taking alginate products consistently can help prevent future reflux episodes.
There is plenty of research that supports the effectiveness of alginate rafts in treating GERD and its related complications.
One study compared the efficacy of an alginate preparation mixed with an antacid versus a non-raft-forming antacid preparation. The former preparation led to the creation of a raft located just under the lower esophageal sphincter. This physical barrier blocked acid reflux that typically occurs after a meal. Conversely, the non-raft-forming antacid was less effective in protecting the esophagus.
Another study recruited volunteers with symptomatic GERD coupled with hiatal hernia. Participants were divided into two groups:
· The first group took an alginate-antacid preparation
· The second group received a non-raft forming antacid
All volunteers consumed a meal and were instructed to report any reflux episodes. The first group had significantly fewer episodes than the second one. Additionally, the time it takes to develop acid reflux after a meal increased significantly for the first group (around one hour) compared to the second group (14 minutes).
This means that alginate-antacid preparations help with preventing the symptoms of GERD and lowering their frequency.
So, where can you get these preparations? Unfortunately, the internet is full of misleading ads that sell questionable products. Because Alginate-antacid preparations are sold in the form of supplements, there are no regulations that instruct manufacturers on how to develop these products. Many manufacturers use a random assortment of ingredients so you don’t know about the efficacy of the ingredients you are taking. Sometimes manufacturers include ingredients that you don’t want like aluminum and parabens. Other times, manufacturers include sweeteners using a sugar like dextrose or sugar substitutes like stevia or xylitol that can cause bloating and gastric distress.
You want to control GERD, not make it worse. This is why you need a brand that you trust; you need Refluxter by Nutritist. Nutritist’s founder is an M.D. who studied clinical research papers such as the ones mentioned in this article and used the ingredients mentioned in the papers in their correct effective dosages when he created Refluxter. For example, a leading competitor doesn't even use calcium carbonate, but instead uses calcium pantothenate, a form of Vitamin B5!
Of importance, Refluxter has the most of the key ingredient sodium alginate in its formula compared to its competitors. By law manufacturers have to list ingredients in order of quantity present. According to FDA regulations, ingredients must be listed in descending order of predominance by weight The first ingredient listed in Refluxter's alginate complex is sodium alginate, and the complex itself weighs 1,400 mg per serving. Competitor product Reflux Gourmet lists calcium pantothenate as the first ingredient in its alginate complex, followed by sodium alginate. The complex itself weighs 425 mg per serving. Therefore, by FDA regulation sodium alginate cannot comprise more than 50% (213 mg) of the complex since it is the second ingredient listed. Competitor product Reflux Raft PM lists calcium carbonate as the first ingredient in its alginate complex, followed by sodium alginate. The complex itself weighs 306 mg per serving. Many people report that taking the recommended serving of 5 ml of those competitor products is not enough to relieve their symptoms. Even if you were to double the dose to 10 ml, you still wouldn't get as much sodium alginate per serving compared to Refluxter. Refluxter also has no sugars or artificial sweeteners and isn't an inconvenient gel that needs to be measured, but a simple to swallow capsule. For these reasons, Refluxter is the best alginate formula for acid reflux.
If you are ready to make the smart choice like many of our readers already have, check out Refluxter to stop GERD symptoms and prevent Barrett’s esophagus/esophageal cancer.
How lifestyle changes can help with GERD and Barrett’s esophagus
Making lifestyle changes can also help you control the symptoms of GERD and Barrett’s esophagus.
Here are some of these changes:
· Lose weight and maintain healthy body composition.
· Avoid wearing tight-fitting clothes.
· Stop smoking (we know it’s easier said than done).
· Don’t lie down or stoop shortly after eating.
· Place wooden blocks underneath your bed to raise the head by 6–8 inches so you sleep on an incline. Early in the night when you start sleeping is the time when the most acid refluxes up into the esophagus since you are flat when sleeping and don’t have the help of gravity to keep acid down. This is why it is important to sleep on an inclined bed.
Speaking with your primary care physician or gastroenterologist about other lifestyle measures to manage GERD can also be helpful. Your doctor has your medical and surgical history, allowing them to create a personalized plan based on your needs.
Takeaway message
Untreated gastroesophageal reflux disease can eventually lead to Barrett’s esophagus, which increases the risk of esophageal cancer. The best way to prevent cancer is to address GERD before it triggers Barrett’s esophagus. Nutritist Refluxter forms a temporary physical foam barrier that helps prevent acid from rising up from the stomach and into the esophagus damaging it. Taking Refluxter regularly at night before sleep can help prevent acid from damaging your esophagus while you are laying flat sleeping, especially during the early part of the night when the most acid is produced as Refluxter's foam raft can last up to 4 hours.
We hope that this article managed to highlight the different aspects of Barrett’s esophagus and how treating GERD can prevent this condition, as well as esophageal cancer.
If you have any questions, concerns, or personal experiences with Barrett’s esophagus, please do not hesitate to share your thoughts in the comment section below. You can also reach out to us via Twitter @nutritist_real
Disclaimer: This article is not intended to provide medical advice. This article is intended for informational and educational purposes only and is not intended to substitute for professional medical advice, diagnosis, or treatment. This article does not constitute the formation of a patient-physician relationship. The statements in this article have not been evaluated by the Food and Drug Administration. Refluxter is not intended to diagnose, treat, cure or prevent any disease. Please consult your physician for medical advice.
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