Don't Ignore Frequent Heartburn! - Let's Talk About Barrett's Esophagus

Do you also often get heartburn? It feels like your chest is on fire. Sometimes after eating, especially at night when you lie down after eating, do you feel like something sour and bitter comes out of your mouth? Many of us think this is "gastritis" and take a medicine from a pharmacy and just drink it. But did you know that if this condition continues for a long time, it can damage our esophagus? This is a serious condition that can occur as a result of that damage, which is called `Barrett's Esophagus`. Don't be afraid, let's talk about this simply.

Simply put, what is Barrett's Esophagus?

Think of our esophagus as a water pipe. This is the tube that carries the food we eat from our mouth to our stomach. Like everywhere else in our body, the inside of this tube has a thin, protective layer of cells (lining). Its job is to protect the esophagus.

Now imagine that the harsh acids in our stomach are constantly coming up and hitting the walls of this esophagus. Just like when something harsh keeps falling on the floor, that floor gets burned, these acidic pathways damage the delicate cell layer of the esophagus.

As this damage continues to occur over the years, our body tries to find a solution. The body thinks, "The cells in this esophagus can't handle this acid attack. I'd better make a stronger, acid-resistant type of cell here."

So what the body does is replace the damaged cells in the esophagus with a type of cell that is more resistant to acid than the type found in our intestines. Simply put, instead of the type of cell that should be in the esophagus, a type of cell that is found in the intestine starts to grow in the esophagus. In medicine, we call this intestinal metaplasia . That's what we call `Barrett's Esophagus`.

How serious is this situation? Should we be afraid?

This may scare you. We all get scared when we hear the word "cancer risk." But the important thing to understand here is that not everyone with Barrett's Esophagus will develop cancer.

In fact, the risk of developing cancer is very low . Research has found that the risk is 0.5% per year, which is less than 1%. This means that only one in 200 people with Barrett's Esophagus will develop cancer within a year.

Also, this cell change does not become cancer overnight. It is a very gradual process. Before it goes from the state of `metaplasia` to `cancer`, it goes through another intermediate stage. We call it `dysplasia`. At this stage of `dysplasia`, doctors can recognize it. If they can recognize it, they can remove that changed cell part and stop it from progressing to cancer.

That's why doctors regularly examine and monitor people with Barrett's Esophagus.

What are the symptoms of Barrett's Esophagus?

The surprising thing here is that there are no symptoms specific to Barrett's Esophagus. That is, you don't feel that the cells in your esophagus have changed.

So how do you find this?

Usually, the underlying problem that is causing this condition is the reason you are experiencing symptoms. For the majority of people, this is caused by a condition called gastroesophageal reflux disease . As we all know, this is what GERD (Gastroesophageal Reflux Disease) is called. This is when stomach acid comes up and enters the esophagus.

So you are experiencing these symptoms of GERD:

• Heartburn: A burning sensation that comes from the middle of the chest.
• Sour throat: The feeling of stomach contents, i.e. acid and undigested food, coming up into the mouth.
• Difficulty swallowing: A feeling of choking when swallowing food or drink.
• Persistent sore throat or cough.
• Chest pain.

What are the risk factors that contribute to this condition?

Although the main cause of Barrett's Esophagus is long-term damage to the esophagus, not everyone develops it. However, some people are at higher risk. Let's take a look at who they are.

How do you know if you have Barrett's Esophagus?

If you have long-term symptoms of GERD, your doctor will refer you to a gastroenterologist. He or she will perform a test to confirm whether you have this condition. This is called an endoscopy .

What is an endoscopy test?

This involves giving you a little sedation , and then passing a thin, flexible tube with a camera on the end through your mouth and down your esophagus into your stomach. You won't feel any pain during this procedure.

With this camera, the doctor can clearly see the inside wall of the esophagus.

• The inner wall of a normal esophagus is light pink in color and has a smooth surface.
• Barrett's Esophagus appears reddish-orange (salmon-colored) and rough.

If a change in appearance is seen in this way, the doctor will take a very small piece of tissue from the suspicious area for examination. We call this a biopsy . This piece of tissue is examined under a microscope to confirm 100% whether the cells have actually changed, meaning whether you have Barrett's Esophagus.

Barrett's Esophagus Classification and Stages

Once your biopsy report comes in, your doctor will explain the condition to you. It is usually divided into two types and several stages.

What are the treatments for Barrett's Esophagus?

Treatment methods can be divided into three main parts.

1. Treating the underlying cause

This is the most important thing. We need to stop damaging the esophagus. The majority of cases are caused by GERD, which is treated.

• Lifestyle changes: Reduce spicy, oily foods, coffee, etc. Avoid lying down for 2-3 hours after eating at night.
• Medications: Medications that control the production of acid in the stomach are given. Proton Pump Inhibitors (PPIs) such as `Omeprazole` and `Esomeprazole` are very effective for this. These stop the damage to the esophagus and help it heal.

2. Surveillance

If your condition is free of dysplasia, meaning your risk of cancer is at a low level, your doctor will likely recommend that you have an endoscopy every few years to monitor your condition. If you have dysplasia, you will need to have an endoscopy at least once a year.

3. Removal of pre-cancerous cells (Dysplasia)

If your report says you have ``high-grade dysplasia,'' meaning you have a high risk of cancer, your doctor will recommend removing the abnormal cells. There are several ways to do this.

• Ablation Therapy: In this, a device is passed through the endoscopy tube and the bad cells are destroyed using radiofrequency or cryotherapy.
• Endoscopic Mucosal Resection (EMR): This is also a minor surgery performed through `endoscopy`. In this, the abnormal tissue is cut out and removed.
• Surgery (Esophagectomy): If the dysplasia is severe or has progressed to cancer, surgery may be required to remove the damaged part of the esophagus.

Can this condition be completely cured?

Metaplasia, or cell change, does not go away on its own. However, the treatments mentioned above can help remove the damaged tissue. Also, if GERD is well controlled, further damage can be prevented.

But even after treatment, there is a small chance that this condition may recur, so it is very important to continue to attend the tests your doctor recommends.

A person with Barrett's Esophagus can live a normal life. The most important thing is to recognize the condition early, and to follow proper treatment and medical advice before it gets worse. If you do that, you can avoid serious conditions like cancer and live a healthy life.

Barrett's Esophagus, GERD, heartburn, esophagus, cancer, endoscopy, biopsy, acid reflux, regurgitation