Barrett's Esophagus

Barrett's Esophagus

Barrett's esophagus (BE) is a serious condition in which changes occur in the cells that line the lower esophagus and cause the cells to become abnormal and precancerous. Barrett's esophagus is categorized as either long-segment or short segment disease:

• Long-segment BE occurs when abnormal cells affect 3 cm or more of the esophagus. This condition occurs in about 3% to 7% of GERD patients. It is associated with a more severe condition.
• Short-segment BE affects less than 3 cm of the esophagus and is found in about 10% to 17% of GERD patients.

Risk Factors for Barrett's Esophagus

About 10% of patients with symptomatic GERD have BE. In some cases, BE develops as an advanced stage of erosive esophagitis. Some studies suggest that individuals at highest risk for BE are obese white males over the age of 50 with persistent GERD who drink alcohol. However, a number of studies have reported no relationship between alcohol use or being male and overweight with BE. Such studies have also reported no higher risk in smokers or relatives of BE patients. Only the persistence of symptoms suggested a higher risk. Nevertheless, not all patient with BE have either esophagitis or symptoms of GERD.

The true prevalence of BE, in fact, is not entirely clear, since studies in 2001 and 2002 suggest that significantly more than half of people with BE have no GERD symptoms at all. BE, then, is likely to be much more prevalent and probably less harmful than is currently believed. (BE that occurs without symptoms can only be identified in clinical trials or in autopsies, so it is difficult to determine the true extent.) Some recent evidence suggests that the presence of specific immune factors may be involved in determining the development of BE.

Barrett's Esophagus and Cancer

Esophageal cancer is one of the most rapidly increasing cancers in North America. The American Cancer Society estimates that there will be 14,550 new cases of esophageal cancer in 2006 and that there will be approximately 13,770 deaths from this disease per year. Esophageal cancer is also very difficult to cure. The 5-year survival rate for all stages of esophageal cancer is 15%. Most cases of esophageal cancer start with BE, with less than half of the cases developing with any symptoms. Of note, only a minority of BE patients develop cancer. Some evidence suggests that acid reflux may contribute to the development of cancer in BE. In fact, current evidence suggests that asymptomatic BE is quite common in the general population, and if true, BE would pose far less of a threat than is now believed. (GERD itself poses no significant risk for esophageal cancer. One study reported an annual incidence of 6.5 cancer cases per 10,000 people with regular GERD symptoms.)

Monitoring for Barrett's Esophagus and Cancer

Barrett's esophagus is diagnosed using endoscopy a procedure that involves inserting a tube down the throat so that the physician can view the esophagus.

Monitoring High-Risk GERD Patients. Some experts recommend a one-time screening test for BE using endoscopy in high risk patients (e.g., Caucasian overweight men) with chronic GERD.