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| Health Science |
| Barrett's Esophagus |
Barrett's esophagus is a condition in which the esophagus,
the muscular tube that carries food and saliva from the
mouth to the stomach, changes so that some of its lining is
replaced by a type of tissue similar to that normally found in
the intestine. This process is called intestinal metaplasia.
While Barrett's esophagus may cause no symptoms itself, a
small number of people with this condition develop a
relatively rare but often deadly type of cancer of the
esophagus called esophageal adenocarcinoma. Barrett's
esophagus is estimated to affect about 700,000 adults in the
United States. It is associated with the very common
condition gastroesophageal reflux disease or GERD.
Normal Function of the Esophagus
The esophagus seems to have only one important function in
the body—to carry food, liquids, and saliva from the mouth
to the stomach. The stomach then acts as a container to
start digestion and pump food and liquids into the intestines
in a controlled process. Food can then be properly digested
over time, and nutrients can be absorbed by the intestines.
The esophagus transports food to the stomach by
coordinated contractions of its muscular lining. This process
is automatic and people are usually not aware of it. Many
people have felt their esophagus when they swallow
something too large, try to eat too quickly, or drink very hot
or very cold liquids. They then feel the movement of the food
or drink down the esophagus into the stomach, which may
be an uncomfortable sensation.
The muscular layers of the esophagus are normally pinched
together at both the upper and lower ends by muscles called
sphincters. When a person swallows, the sphincters relax
automatically to allow food or drink to pass from the mouth
into the stomach. The muscles then close rapidly to prevent
the swallowed food or drink from leaking out of the stomach
back into the esophagus or into the mouth. These sphincters
make it possible to swallow while lying down or even upside-
down. When people belch to release swallowed air or gas
from carbonated beverages, the sphincters relax and small
amounts of food or drink may come back up briefly; this
condition is called reflux. The esophagus quickly squeezes
the material back into the stomach. This amount of reflux
and the reaction to it by the esophagus are considered
normal.
While these functions of the esophagus are obviously an
important part of everyday life, people who must have their
esophagus removed, for example because of cancer, can live
a relatively healthy life without it.
GERD
Having occasional liquid or gas reflux is considered normal.
When it happens frequently, particularly when not trying to
belch, and causes other symptoms, it is considered a medical
problem or disease. However, it is not necessarily a serious
one that requires seeing a physician.
The stomach produces acid and enzymes to digest food.
When this mixture refluxes into the esophagus more
frequently than normal, or for a longer period of time than
normal, it may produce symptoms. These symptoms, often
called acid reflux, are usually described by people as
heartburn, indigestion, or "gas." The symptoms typically
consist of a burning sensation below and behind the lower
part of the breastbone or sternum.
Almost everyone has experienced these symptoms at least
once, typically after overeating. GERD symptoms can also
result from being overweight, eating certain types of foods,
or being pregnant. In most people, GERD symptoms last
only a short time and require no treatment at all. More
persistent symptoms are often quickly relieved by over-the-
counter acid-reducing agents such as antacids. Common
antacids are
* Alka-Seltzer
* Maalox
* Mylanta
* Pepto-Bismol
* Riopan
* Rolaids
Other drugs used to relieve GERD symptoms are
antisecretory drugs such as histamine2 (H2) blockers or
proton pump inhibitors. Common H2 blockers are
* cimetidine (Tagamet HB)
* famotidine (Pepcid AC)
* nizatidine (Axid AR)
* ranitidine (Zantac 75)
Common proton pump inhibitors are
* esomeprazole (Nexium)
* lansoprazole (Prevacid)
* omeprazole (Prilosec)
* pantoprazole (Protonix)
* rabeprazole (Aciphex)
People who have GERD symptoms frequently should consult
a physician. Other diseases can have similar symptoms, and
prescription medications in combination with other measures
might be needed to reduce reflux. GERD that is untreated
over a long period of time can lead to complications, such as
an ulcer in the esophagus that could cause bleeding. Another
common complication is scar tissue that blocks the
movement of swallowed food and drink through the
esophagus; this condition is called stricture.
Esophageal reflux may also cause certain less common
symptoms, such as hoarseness or chronic cough, and
sometimes provokes conditions such as asthma. While most
patients find that lifestyle modifications and acid-blocking
drugs relieve their symptoms, doctors occasionally
recommend surgery. Overall, more than 60 million American
adults experience GERD, making it one of the most common
medical conditions.
GERD and Barrett's Esophagus
The exact causes of Barrett's esophagus are not known, but
it is thought to be caused in part by the same factors that
cause GERD. Although people who do not have heartburn
can have Barrett's esophagus, it is found about three to five
times more often in people with this condition.
Barrett's esophagus is uncommon in children. The average
age at diagnosis is 60, but it is usually difficult to determine
when the problem started. It is about twice as common in
men as in women and much more common in white men than
in men of other races.
Barrett's Esophagus and Cancer of the Esophagus
Barrett's esophagus does not cause symptoms itself and is
important only because it seems to precede the development
of a particular kind of cancer—esophageal adenocarcinoma.
The risk of developing adenocarcinoma is 30 to 125 times
higher in people who have Barrett's esophagus than in
people who do not. This type of cancer is increasing rapidly in
white men. This increase may be related to the rise in obesity
and GERD.
For people who have Barrett's esophagus, the risk of getting
cancer of the esophagus is small: less than 1 percent (0.4
percent to 0.5 percent) per year. Esophageal
adenocarcinoma is often not curable, partly because the
disease is frequently discovered at a late stage and because
treatments are not effective.
Diagnosis and Screening
Barrett's esophagus can only be diagnosed by an upper GI
endoscopy to obtain biopsies of the esophagus. At present,
it cannot be diagnosed on the basis of symptoms, physical
exam, or blood tests. In an upper GI endoscopy, a flexible
tube called an endoscope, which has a light and miniature
camera, is passed into the esophagus. If the tissue appears
suspicious, then biopsies must be done. A biopsy is the
removal of a small piece of tissue using a pincher-like device
passed through the endoscope. A pathologist examines the
tissue under a microscope to confirm the diagnosis.
Looking for a medical problem in people who do not know
whether they have one is called screening. Currently, there
are no commonly accepted guidelines on who should have
endoscopy to check for Barrett's esophagus. Among the
many reasons for the lack of firm recommendations about
screening are the great expense and occasional risk of side
effects of the test. Also, the rate of finding Barrett's
esophagus is low, and finding the problem early has not been
proven to prevent deaths from cancer.
Many physicians recommend that adult patients who are over
the age of 40 and have had GERD symptoms for a number
of years have endoscopy to see whether they have Barrett's
esophagus. Screening for this condition in people who have
no symptoms is not recommended.
Treatment
Barrett's esophagus has no cure, short of surgical removal
of the esophagus, which is a serious operation. Surgery is
recommended only for people who have a high risk of
developing cancer or who already have it. Most physicians
recommend treating GERD with acid-blocking drugs, since
this is sometimes associated with improvement in the extent
of the Barrett's tissue. However, this approach has not been
proven to reduce the risk of cancer. Treating reflux with a
surgical procedure for GERD also does not seem to cure
Barrett's esophagus.
Several different experimental approaches are under study.
One attempts to see whether destroying the Barrett's tissue
by heat or other means through an endoscope can eliminate
the condition. This approach, however, has potential risks
and unknown effectiveness.
Surveillance for Dysplasia and Cancer
Periodic endoscopic examinations to look for early warning
signs of cancer are generally recommended for people who
have Barrett's esophagus. This approach is called
surveillance. When people who have Barrett's esophagus
develop cancer, the process seems to go through an
intermediate stage in which cancer cells appear in the
Barrett's tissue. This condition is called dysplasia and can be
seen only in biopsies with a microscope. The process is
patchy and cannot be seen directly through the endoscope,
so multiple biopsies must be taken. Even then, the cancer
cells can be missed.
The process of change from Barrett's to cancer seems to
happen in only a few patients, less than 1 percent per year,
and over a relatively long period of time. Most physicians
recommend that patients with Barrett's esophagus undergo
periodic surveillance endoscopy to have biopsies. The
recommended interval between endoscopies varies depending
on specific circumstances, and the ideal interval has not been
determined.
Treatment for Dysplasia or Esophageal Adenocarcinoma
If a person with Barrett's esophagus is found to have
dysplasia or cancer, the doctor will usually recommend
surgery if the person is strong enough and has a good
chance of being cured. The type of surgery may vary, but it
usually involves removing most of the esophagus and pulling
the stomach up into the chest to attach it to what remains of
the esophagus. Many patients with Barrett's esophagus are
elderly and have many other medical problems that make
surgery unwise; in these patients, other approaches to
treating dysplasia are being investigated.
Content Credit NDDIC
the muscular tube that carries food and saliva from the
mouth to the stomach, changes so that some of its lining is
replaced by a type of tissue similar to that normally found in
the intestine. This process is called intestinal metaplasia.
While Barrett's esophagus may cause no symptoms itself, a
small number of people with this condition develop a
relatively rare but often deadly type of cancer of the
esophagus called esophageal adenocarcinoma. Barrett's
esophagus is estimated to affect about 700,000 adults in the
United States. It is associated with the very common
condition gastroesophageal reflux disease or GERD.
Normal Function of the Esophagus
The esophagus seems to have only one important function in
the body—to carry food, liquids, and saliva from the mouth
to the stomach. The stomach then acts as a container to
start digestion and pump food and liquids into the intestines
in a controlled process. Food can then be properly digested
over time, and nutrients can be absorbed by the intestines.
The esophagus transports food to the stomach by
coordinated contractions of its muscular lining. This process
is automatic and people are usually not aware of it. Many
people have felt their esophagus when they swallow
something too large, try to eat too quickly, or drink very hot
or very cold liquids. They then feel the movement of the food
or drink down the esophagus into the stomach, which may
be an uncomfortable sensation.
The muscular layers of the esophagus are normally pinched
together at both the upper and lower ends by muscles called
sphincters. When a person swallows, the sphincters relax
automatically to allow food or drink to pass from the mouth
into the stomach. The muscles then close rapidly to prevent
the swallowed food or drink from leaking out of the stomach
back into the esophagus or into the mouth. These sphincters
make it possible to swallow while lying down or even upside-
down. When people belch to release swallowed air or gas
from carbonated beverages, the sphincters relax and small
amounts of food or drink may come back up briefly; this
condition is called reflux. The esophagus quickly squeezes
the material back into the stomach. This amount of reflux
and the reaction to it by the esophagus are considered
normal.
While these functions of the esophagus are obviously an
important part of everyday life, people who must have their
esophagus removed, for example because of cancer, can live
a relatively healthy life without it.
GERD
Having occasional liquid or gas reflux is considered normal.
When it happens frequently, particularly when not trying to
belch, and causes other symptoms, it is considered a medical
problem or disease. However, it is not necessarily a serious
one that requires seeing a physician.
The stomach produces acid and enzymes to digest food.
When this mixture refluxes into the esophagus more
frequently than normal, or for a longer period of time than
normal, it may produce symptoms. These symptoms, often
called acid reflux, are usually described by people as
heartburn, indigestion, or "gas." The symptoms typically
consist of a burning sensation below and behind the lower
part of the breastbone or sternum.
Almost everyone has experienced these symptoms at least
once, typically after overeating. GERD symptoms can also
result from being overweight, eating certain types of foods,
or being pregnant. In most people, GERD symptoms last
only a short time and require no treatment at all. More
persistent symptoms are often quickly relieved by over-the-
counter acid-reducing agents such as antacids. Common
antacids are
* Alka-Seltzer
* Maalox
* Mylanta
* Pepto-Bismol
* Riopan
* Rolaids
Other drugs used to relieve GERD symptoms are
antisecretory drugs such as histamine2 (H2) blockers or
proton pump inhibitors. Common H2 blockers are
* cimetidine (Tagamet HB)
* famotidine (Pepcid AC)
* nizatidine (Axid AR)
* ranitidine (Zantac 75)
Common proton pump inhibitors are
* esomeprazole (Nexium)
* lansoprazole (Prevacid)
* omeprazole (Prilosec)
* pantoprazole (Protonix)
* rabeprazole (Aciphex)
People who have GERD symptoms frequently should consult
a physician. Other diseases can have similar symptoms, and
prescription medications in combination with other measures
might be needed to reduce reflux. GERD that is untreated
over a long period of time can lead to complications, such as
an ulcer in the esophagus that could cause bleeding. Another
common complication is scar tissue that blocks the
movement of swallowed food and drink through the
esophagus; this condition is called stricture.
Esophageal reflux may also cause certain less common
symptoms, such as hoarseness or chronic cough, and
sometimes provokes conditions such as asthma. While most
patients find that lifestyle modifications and acid-blocking
drugs relieve their symptoms, doctors occasionally
recommend surgery. Overall, more than 60 million American
adults experience GERD, making it one of the most common
medical conditions.
GERD and Barrett's Esophagus
The exact causes of Barrett's esophagus are not known, but
it is thought to be caused in part by the same factors that
cause GERD. Although people who do not have heartburn
can have Barrett's esophagus, it is found about three to five
times more often in people with this condition.
Barrett's esophagus is uncommon in children. The average
age at diagnosis is 60, but it is usually difficult to determine
when the problem started. It is about twice as common in
men as in women and much more common in white men than
in men of other races.
Barrett's Esophagus and Cancer of the Esophagus
Barrett's esophagus does not cause symptoms itself and is
important only because it seems to precede the development
of a particular kind of cancer—esophageal adenocarcinoma.
The risk of developing adenocarcinoma is 30 to 125 times
higher in people who have Barrett's esophagus than in
people who do not. This type of cancer is increasing rapidly in
white men. This increase may be related to the rise in obesity
and GERD.
For people who have Barrett's esophagus, the risk of getting
cancer of the esophagus is small: less than 1 percent (0.4
percent to 0.5 percent) per year. Esophageal
adenocarcinoma is often not curable, partly because the
disease is frequently discovered at a late stage and because
treatments are not effective.
Diagnosis and Screening
Barrett's esophagus can only be diagnosed by an upper GI
endoscopy to obtain biopsies of the esophagus. At present,
it cannot be diagnosed on the basis of symptoms, physical
exam, or blood tests. In an upper GI endoscopy, a flexible
tube called an endoscope, which has a light and miniature
camera, is passed into the esophagus. If the tissue appears
suspicious, then biopsies must be done. A biopsy is the
removal of a small piece of tissue using a pincher-like device
passed through the endoscope. A pathologist examines the
tissue under a microscope to confirm the diagnosis.
Looking for a medical problem in people who do not know
whether they have one is called screening. Currently, there
are no commonly accepted guidelines on who should have
endoscopy to check for Barrett's esophagus. Among the
many reasons for the lack of firm recommendations about
screening are the great expense and occasional risk of side
effects of the test. Also, the rate of finding Barrett's
esophagus is low, and finding the problem early has not been
proven to prevent deaths from cancer.
Many physicians recommend that adult patients who are over
the age of 40 and have had GERD symptoms for a number
of years have endoscopy to see whether they have Barrett's
esophagus. Screening for this condition in people who have
no symptoms is not recommended.
Treatment
Barrett's esophagus has no cure, short of surgical removal
of the esophagus, which is a serious operation. Surgery is
recommended only for people who have a high risk of
developing cancer or who already have it. Most physicians
recommend treating GERD with acid-blocking drugs, since
this is sometimes associated with improvement in the extent
of the Barrett's tissue. However, this approach has not been
proven to reduce the risk of cancer. Treating reflux with a
surgical procedure for GERD also does not seem to cure
Barrett's esophagus.
Several different experimental approaches are under study.
One attempts to see whether destroying the Barrett's tissue
by heat or other means through an endoscope can eliminate
the condition. This approach, however, has potential risks
and unknown effectiveness.
Surveillance for Dysplasia and Cancer
Periodic endoscopic examinations to look for early warning
signs of cancer are generally recommended for people who
have Barrett's esophagus. This approach is called
surveillance. When people who have Barrett's esophagus
develop cancer, the process seems to go through an
intermediate stage in which cancer cells appear in the
Barrett's tissue. This condition is called dysplasia and can be
seen only in biopsies with a microscope. The process is
patchy and cannot be seen directly through the endoscope,
so multiple biopsies must be taken. Even then, the cancer
cells can be missed.
The process of change from Barrett's to cancer seems to
happen in only a few patients, less than 1 percent per year,
and over a relatively long period of time. Most physicians
recommend that patients with Barrett's esophagus undergo
periodic surveillance endoscopy to have biopsies. The
recommended interval between endoscopies varies depending
on specific circumstances, and the ideal interval has not been
determined.
Treatment for Dysplasia or Esophageal Adenocarcinoma
If a person with Barrett's esophagus is found to have
dysplasia or cancer, the doctor will usually recommend
surgery if the person is strong enough and has a good
chance of being cured. The type of surgery may vary, but it
usually involves removing most of the esophagus and pulling
the stomach up into the chest to attach it to what remains of
the esophagus. Many patients with Barrett's esophagus are
elderly and have many other medical problems that make
surgery unwise; in these patients, other approaches to
treating dysplasia are being investigated.
Content Credit NDDIC
| MEDICAL NOTES |
DISEASES AND
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo
CONDITIONS
Acidosis
Acne
Acromegaly
Addison's Disease
Adrenal Crisis
Age. macular degn
Alzheimer's disease
Autoimmune
Hepatitis
Barrett's Esophagus
Cancer
Constipation
Colon Polyps
Crohns Disease
Cushing's Syndrm.
Diabetes
Erectile Dysfunction
Fecal Incontinence
Gallstones
Gastritis
Gastroenteritis
Gastroesophageal
Reflux (GERD)
Growth Hormone
Def.
Heartburn
Hemochromatosis
Hemorrhoids
Hyperparathyroidism
Hypertension
Inflam. Bowel Dis.
Kidney Stone
Liver Cirrhosis
Migraines
Multiple Sclerosis
Obesity
Osteorithritis
Osteoporosis
Pancreatitis
Parkinson's Disease
Peyronies' Disease
Prolactinoma
Psoriasis
Sprain and Strain
Stroke
Ulcerative Colitis
Urin. Incontinence
Vitiligo