Barrett’s Esophagus

June 11, 2009
 Barrett’s Esophagus, also known as intestinal metaplasia, is a transformation of the lining of the esophagus caused by exposure to regurgitated gastric contents. This transformed tissue is much more likely to develop esophageal cancer than normal esophageal lining. Acid is not thought to be the sole cause, as there are also enzymes and bile salts in the stomach that can damage the esophagus. Patients with Barrett’s are more likely to have these other substances present in their stomach and regurgitate them. For this reason, acid-reducing medicine alone may not be effective treatment for Barrett’s esophagus. Many studies have shown surgery to be superior to medications in the treatment of Barrett’s esophagus.

Patients with Barrett’s esophagus should have regular endoscopic examinations, and will require extensive endoscopic biopsies, done at the time of EGD, to evaluate for further changes that indicate an even higher risk of cancer. These changes, called dysplasia, are associated with a significant chance of cancer development, and require closer surveillance or additional, more aggressive treatment than medicine alone.

Barrett’s esophagus is known to increase the risk of esophageal cancer many times compared to normal. Estimates are that the risk increase is 40-120 times normal, and 0.5% of Barrett’s patients will develop cancer each year.

One strategy for managing Barrett’s esophagus is to destroy the abnormal tissue with radio frequency waves. This endoscopically administered radiofrequency ablation, or HALO procedure , has been shown to be effective in eliminating Barrett’s tissue. After ablation, patients may chose to continue medical therapy or undergo surgery to control their GERD.Dr. Graybeal has extensive experience in performing the HALO procedure.

Some patients will have high grade dysplasia which can be removed endoscopically, rather than destroyed. Still others may be considered at such high risk of invasive esophageal cancer with their Barrett’s that only surgical removal will be considered reliably safe treatment.