A: Barrett's esophagus is a condition of the esophagus in which the cells lining the esophagus transform from a pink, squamous cell to a salmon colored columnar cell. It is believed to occur as a result of acid damage to the end of the esophagus and occurs in up to 10% of patients with heartburn.
Interestingly, the body most likely does this as a protective mechanism. Columnar cells are typically found in the stomach and, therefore, are more resistant to acid. That's why patients with Barrett's esophagus may experience improvement in their symptoms.
But it's a false benefit. Once Barrett's esophagus develops, there is roughly a 10% chance of developing esophageal cancer over time. The columnar cells in the end of the esophagus can undergo transformation by developing dysplasia, which is a pre-cancerous change in the esophagus. This transformation typically occurs slowly, progressing from Barrett's without dysplasia, to low-grade dysplasia, then high-grade dysplasia and finally esophageal cancer. It is every important to have the esophagus followed with surveillance endoscopies, even in the absence of symptoms, to ensure that the transformation to esophageal cancer is not developing. Typically, if there is no dysplasia present, your doctor will recommend endoscopy every 2 to 3 years. If however, there is dysplasia, depending on the degree; your doctor will work with you to take steps to prevent the development of cancer. Usually, if low-grade dysplasia is present, more aggressive treatment with twice-a-day Prilosec will be recommended, and endoscopy will likely be performed every 3 to 6 months to ensure stability. If high-grade dysplasia develops, more aggressive action will need to be taken.
Q: Will acid reflux medications used to treat heartburn make my Barrett's Esophagus go away?
A: No. Studies have shown that none of the medications used to treat gastroesophageal reflux disease (GERD), including Prilosec, Nexium, other proton pump inhibitors and H2 receptor blockers can reverse Barrett's esophagus. While these medications typically will result in improvement in symptoms, they will not change the cells in the esophagus and therefore will do nothing to stop the possible progression to dysplasia or esophageal cancer. Additionally, surgical repair of a hiatal hernia, although likely to result in improvement in symptoms of GERD, will also not reverse Barrett's esophagus. It therefore cannot be stressed enough, that even in the absence of symptoms, patients with Barrett's esophagus need to undergo surveillance endoscopy.
Q: I have Barrett's Esophagus and was recently found to have high-grade dysplasia on an upper endoscopy. What are my treatment options?