Barrett's esophagus is an acquired disorder characterized by changes in the color and the composition of the cell lining of the lower esophagus. It is associated with gastroesophageal reflux (GERD), which is a chronic regurgitation of acid from the stomach into the lower esophagus. Most adenocarcinomas (malignant tumors) of the esophagus and many adenocarcinomas of the esophagogastric junction arise in a Barrett's esophagus. (1)
A history of experiencing the symptoms of GERD for more than 10 years increases the risk of Barrett's esophagus. Males are more likely than females to develop this condition. There is a higher risk among Caucasian and Hispanic individuals. Though more common in older adults, Barrett's esophagus has been found in children. It is rare compared to the prevalence in adults and is found in children with severe neurological disease, such as mental retardation and cerebral palsy. (1)
The common presenting complaints are heartburn and acid regurgitation. Dysphasia (difficulty swallowing), due to stricture or inflammation, may occur. Pain or bleeding may result from esophagitis (inflammation that damages the tissues of the esophagus) or, occasionally, from the development of an ulcer within the esophagus.
Endoscopy is the principle method for diagnosing Barrett's esophagus. A biopsy is required to confirm the diagnosis. The pathologis examines the biopsy specimen to determine the degree of dysplasia or changes in the cells. Grades of dysplasia range from none to high grade, which is thought to be the precursor to esophageal cancer. (2)
Treatment depends on the grade of dysplasia. It is usual practice to monitor patients with periodic endoscopy and biopsy for early cancer detection. The most effective medications for controlling gastric acid output and reducing esophageal acid reflux are the proton pump inhibitors (PPIs). High-grade dysplasia may require more invasive treatments such as an esophagectomy (removal of most of the esophagus) or endoscopic mucosal resection (removal of the damaged cells using an endoscope).