what is barrett’s esophagus?

About 12 million American adults have Barrett’s esophagus, but only 1.5 million have been diagnosed.8 Barrett’s esophagus can increase a person’s risk of cancer of the esophagus by 50 times or more.4,6,7,9

Barrett’s esophagus is a disease affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth to the stomach. It is caused by injury to the esophagus from the chronic backwash of stomach contents, like acid and enzymes, that occurs with abnormal reflux.

People with Barrett’s esophagus may not have any symptoms.10 However, chronic heartburn, difficulty swallowing, nausea, chest pain and other symptoms of GERD may indicate a need for further testing. It is estimated that 13% of the people who have chronic acid reflux — those in high risk groups including chronic GERD, Caucasian, male, over age 50 — also have Barrett’s esophagus.11

In addition to suffering from chronic heartburn, other factors that may put a person at risk for Barrett’s esophagus include:12

  • Obesity
  • Caucasian ethnicity
  • Family history
  • Male gender

Once a person has Barrett’s esophagus, it may continually progress to more serious stages, potentially resulting in esophageal adenocarcinoma, a type of esophageal cancer. There are three stages of Barrett’s esophagus and range from the least serious (intestinal metaplasia without dysplasia) to the most serious (high-grade dysplasia). Dysplasia refers to the abnormalities of tissue or a cell that make it more cancer-like and disorganized. The presence of dysplasia is not considered cancer, but may increase the risk of developing cancer.3,13 Each stage of Barrett’s esophagus is distinguished by the following:

type

The normal epithelium (lining) of the esophagus is replaced with a type of epithelium resembling that found in the intestine.

Cells appear abnormal when viewed under a microscope and represent a very early stage of pre-cancer of the esophagus.

Cells appear very abnormal when viewed under a microscope and represent a more advanced stage of pre-cancer of the esophagus.

Cancer occurs when the abnormal cells involved in Barrett’s esophagus have rapid and uncontrolled growth and invade the deeper layers of your esophagus. This is called cancer of the esophagus, or esophageal adenocarcinoma (EAC). The cancer can also spread beyond the esophagus.

Although still considered rare, EAC is the most rapidly rising cancer in the U.S.13,14 In the U.S., the incidence of esophageal adenocarcinoma rose approximately six-fold from 1975 to 2001.3 In addition, mortality increased more than seven-fold.3 Patients with Barrett’’s esophagus are 30 to 125 times more at risk of developing EAC than patients without the condition.15 Roughly 18% of patients survive at least five years after the diagnosis of esophageal cancer.14

The good news is that there is treatment available. Treatment of Barrett’s esophagus has been shown to reduce the risk of progression to high-grade dysplasia and esophageal adenocarcinoma.16,17

If you or a loved one are at risk for Barrett’s esophagus, find a physician and schedule an appointment today.

References: 1. Vaezi M, Zehrai A, Yuksel E. Testing for refractory gastroesophageal reflux disease, ASGE Leading Edge. 2012;2(2):1-13. American Society Gastroenterology Endoscopy. Page 1-2.  2. Gilbert EW, Luna RA, Harrison VL, Hunter JG. Barrett’s esophagus: a review of the literature. J Gastrointest Surg. 2011;15:708-18.  3. Pohl H, Welch HG. The role of over diagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142-6.  4. SEER Cancer Statistics Factsheets: Esophageal Cancer. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/esoph.html.  5. Dymedex Market Development Consulting, Strategic Market Assessment: Barrx - GI, October 30, 2014.  6. De Jonge PJ, van Blankenstein M, Looman CW, Casparie MK, Meijer GA, Kuipers EJ. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut. 2010;59:1030-6.  7. Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375-83.  8. Dymedex Market Development Consulting, GERD Sizing and Segmentation for pH Testing, February 13 2015.  9. Wani S, Falk G, Hall M, Gaddam S, Wang A, Gupta N, et al. Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2011;9(3):220-7.  10. Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373(9666):850-61.  11. Westhoff B, Brotze S, Weston A, McElhinney C, Cherian R, Mayo MS, et al. The frequency of Barrett’s esophagus in high-risk patients with chronic GERD. Gastrointestinal Endoscopy. 2005;61(2):226-231.  12. Spechler SJ, Souza RF. Barrett’s esophagus. NEJM. 2014;371:836-45.  13. Reid BJ, Weinstein WM. Barrett’s esophagus and adenocarcinoma. Gastroenterology Clinics of North America. 1987;38:477-92.  14. "What Are the Key Statistics about Cancer of the Esophagus?" Cancer.org. 2006. American Cancer Society. Accessed October 2007.  15. Eisen GM. Ablation therapy for Barrett's esophagus. Gastrointestinal Endosc. 2003;58:760-9.  16. Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311(12)1209-17. doi:10.1001/jama.2014.2511.  17. Wolf WA, Pasricha S, Cotton C, Li N, Triadafilopoulos G, Raman Muthusamy V, et al.  Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus. Gastroenterology. 2015;149(7):1752-1761.