What are the Best Options for Barrett’s Esophagus Treatment?

Barrett’s esophagus is a condition in which the cells that make up the tissue that lines the esophagus have abnormal growth, making them more like the cells in the lining of the intestines. These abnormalities are caused by repeated and long term exposure to stomach acid. 

According to the American College of Gastroenterology (ACG), it is most common in people who have chronic gastroesophageal reflux disease (GERD), commonly referred to as heartburn or acid reflux. The symptoms of Barrett’s esophagus are caused by GERD. They may include frequent heartburn, difficulty swallowing, and chest pain. However, some people do not have any symptoms of the condition. 

There are several options for Barrett’s esophagus treatment, but not all procedures are right for all patients. Before treatment can be recommended, the proper screening and diagnostic procedures need to be done.

Screening

Certain people with GERD are at a greater risk of developing Barrett’s. Doctors often recommend that these people get screened even if they do not have obvious symptoms. Men are more likely to have the condition, so they are most often screened. Women should still be screened if they have reflux that does not respond to medication or diet changes or other risk factors.  According to the Mayo Clinic, factors that increase risk include:

• Being over 50
• Being white
• Having excess fat on the abdomen
• Being a smoker now or in the past
• Family history of Barrett’s esophagus or esophageal cancer

Diagnosis

The test most commonly used in the diagnosis of Barrett’s esophagus is the upper endoscopy. During the procedure, an endoscope (a thin tube with a camera and light on the end) is inserted into the esophagus to examine the lining of the esophagus and upper GI system. Testing for Barrett’s includes the collection of tissue samples from the esophageal lining. These samples, or biopsies, are then examined for abnormal cells under a microscope in a lab. If abnormal cells are present, then a diagnosis can be made.

When you are diagnosed with Barrett’s esophagus, the doctor will need to determine how much dysplasia there is in the esophagus. Dysplasia is the term used to describe precancerous changes in cells. The more dysplasia there is, the more likely that Barrett’s esophagus will become esophageal cancer. The extent of dysplasia in the cells will also affect your treatment options.

Treatment Options

Physicians usually start off by treating the symptoms of GERD rather than Barrett’s esophagus itself. However, the options for Barrett’s esophagus treatment are highly dependent on the extent of dysplasia in the esophageal cells. Other health factors may also impact which treatments are safe and effective for patients. 

No or Low-Grade Dysplasia

If there is no or low-grade dysplasia present, then the patient should continue or begin treatment for GERD.

• Medication: There are prescription and over the counter medications available to treat the symptoms of reflux. Two common categories of reflux medications are proton pump inhibitors (PPIs) and H-2 receptor blockers. Both of these medications reduce acid.
• Lifestyle changes: In addition to medication, there are certain lifestyle changes you can make to improve your GERD symptoms. This includes losing weight, eliminating foods that trigger reflux, stopping drinking and quitting smoking. Some people also get relief from elevating their heads while sleeping by putting the head of the bed on risers or sleeping on a special wedge pillow.
• Follow up endoscopies: People with Barrett’s esophagus but no dysplasia will be monitored with periodic endoscopies to check the condition’s progression. Generally, the first follow up is within 3 to 5 years, but your doctor can tell you when you should be checked again,

If there is low-grade dysplasia, an endoscopic procedure called radiofrequency ablation is a frequently used procedure. This treatment uses heat to destroy the abnormal cells in the esophageal lining so that healthy cells can regrow in their place. 

High-Grade Dysplasia

In high-grade dysplasia, there are many changes in the cells. According to the American College of Gastroenterology (ACG), it could be the last stage before esophageal cancer. The most commonly used treatment for high-grade dysplasia is radiofrequency ablation, described above. Other endoscopic treatments may be used as well including:

• Cryotherapy: A cold liquid is applied to the abnormal cells to freeze them. The cells are then allowed to thaw out. After they’ve thawed, the cells are frozen again. This process of repeated freezing and thawing will damage and eventually kill the abnormal cells.
• Photodynamic therapy: The cells are destroyed by making them sensitive to light.

In more extreme cases, the portion of the esophagus damaged by the abnormal cells is removed. The remaining portion of the esophagus is attached to the stomach.

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One of the most important things to do when considering which Barrett’s esophagus treatment is right for you is to ensure you are working with a qualified physician who specializes in gastroenterology. At Birmingham Gastroenterology, we have 14 board-certified gastroenterologists with the expertise to provide you with comprehensive care. To make an appointment to discuss your symptoms or treatment options, call us at (205) 271-8000.