Barrett's Esophagus: What you need to know about the recurring heartburn

Do you often get heartburn? Like gastritis? Do you feel like food is coming back up your throat after eating? Many of us forget about these things, thinking that they are "normal." But behind these seemingly minor symptoms, there may be something we don't think about and that needs a little attention. That is the condition we are talking about in this article today. That is "Barrett's Esophagus."

Simply put, what is Barrett's Esophagus?

Okay, let's explain this very simply. You know that when we swallow food, it goes from our mouth to our stomach through a tube called the esophagus . Like our entire gastrointestinal tract (GI tract), the inside of this esophagus is lined with a thin, protective layer of cells.

But imagine that over a long period of time, something continues to damage or irritate this delicate lining. For example, you could be constantly having stomach acid reflux into your throat. As this continues, the cells in your esophagus can no longer handle the damage. Then, those cells start to change to protect themselves.

Simply put, when the esophagus tries to protect itself, it changes the nature of the cells lining its interior. This is like putting a layer of carpet on top of a regular road when it gets dirty from constant traffic. But these new cells are not the cells that belong to the esophagus.

Is this a dangerous condition? Will it cause cancer?

This question may be the first one that comes to your mind. Here's the answer: Barrett's esophagus is not cancer. However, it is a condition that slightly increases the risk of developing esophageal cancer.

But don't worry. This risk is not as great as you might think. Research has found that the chance of someone with this condition developing cancer per year is very small, around 0.5%.

The important thing is that these cell changes are very gradual. Before the cells become cancerous, they go through another intermediate stage. We call it (Dysplasia) . That is, pre-cancerous cell changes. Doctors can identify this (Dysplasia) stage early, remove those cells and stop cancer from developing. That is why it is important to be aware of this condition.

What are the symptoms of this?

Here's the surprising thing. Barrett's esophagus has no specific symptoms. That means, even if you have the condition, you won't feel any pain or discomfort.

So how do you find this?

We get symptoms because of the underlying cause of this condition. As we discussed earlier, this is due to long-term damage to the esophagus. The main cause of this damage is gastritis (GERD - Gastroesophageal Reflux Disease) . That is, the acid in the stomach often comes up into the esophagus.

So, if you have the following symptoms for a long time, you should be concerned:

• Frequent chest pain: A feeling like there is a fire in the middle of the chest.
• Difficulty swallowing: A feeling like something is stuck in the throat.
• Stomach contents (acid, food) coming up into the throat: A sour taste in the mouth, especially when lying down at night or bending forward.
• Persistent sore throat or cough.
• Chest pain.

Who is at higher risk of developing this?

Although anyone can develop Barrett's esophagus, some people are at a slightly higher risk. Let's take a look at who they are.

How does a doctor find this?

After listening to your symptoms, if the doctor suspects this, he will refer you to a specialist, a gastroenterologist. He will perform a key test to confirm this condition. That is an endoscopy .

What is an endoscopy?

This involves inserting a thin, flexible tube with a camera at the end through your mouth and examining your esophagus, stomach, and the first part of your small intestine. You won't feel any pain during this test, because you'll be sedated.

Looking through the camera, the doctor sees a change in the color and texture of the lining of the vagina.

• While the lining of a normal vagina is light pink and smooth,
• Areas with Barrett's may appear salmon-colored and slightly rough.

When the doctor sees this change, he takes a few very small pieces of tissue from the changed areas. We call this a biopsy . Then, these pieces of tissue are examined under a microscope to confirm 100% whether the cells have actually changed, that is, whether there is a condition called Intestinal Metaplasia.

How do you classify the condition after testing?

Once the biopsy report comes in, the doctor will classify your condition. This is mainly based on two factors.

1. How much of the length of the esophagus has been affected by this change.

2. Whether or not there are precancerous cell changes (dysplasia).

This classification is very important, because it determines what treatments you should receive and how often you should be retested.

What are the treatments for this?

There are three main goals of treating Barrett's esophagus.

1. Stop the condition from getting worse by treating the underlying cause.

2. Regular monitoring for the development of pre-cancerous changes (dysplasia).

3. If dysplasia occurs, remove the affected cells.

1. Treating the underlying cause

Since many people develop this condition due to chronic gastritis (GERD), the first thing to do is to treat it properly. Your doctor will advise you on this:

• Lifestyle changes: Reducing spicy, oily foods, coffee, etc., and not lying down too soon after dinner.
• Medication: Medications that reduce stomach acid production, especially Proton Pump Inhibitors (PPIs) (e.g. Omeprazole, Esomeprazole, Pantoprazole), are very effective. They stop damage to the esophagus and help the tissue heal. These medications should only be taken under the supervision of a doctor.

2. Constant monitoring (Surveillance)

Depending on your condition, your doctor will tell you how often you need to have an endoscopy.

• Otherwise, checking every 3-5 years is sufficient.
• If there is low-grade dysplasia, they recommend checking it about once a year.

3. Treating the condition (Dysplasia)

If a biopsy confirms that there are precancerous cell changes (dysplasia), doctors will recommend removing those cells. There are several methods for this.

• Ablation Therapy: This involves using a special device during an endoscopy to destroy the abnormal cell layer. This can be done using high heat (radiofrequency) or high cold (cryotherapy).
• Endoscopic Mucosal Resection (EMR): This is also a minor surgery performed through endoscopy. Here, only the abnormal tissue is cut out and removed.
• Surgery (Esophagectomy): If the dysplasia is very severe or has progressed to cancer, surgery may be required to completely remove the affected part of the esophagus.

Can this condition be completely cured?

Metaplasia, or the change in cells, does not get better on its own. However, the treatments we discussed earlier (Ablation, EMR) can remove the changed cells. Also, if the underlying cause (like GERD) is properly treated and the damage to the esophagus is stopped, the condition can be controlled.

But even after treatment, there is a small chance that this condition will recur. Therefore, it is very important to continue to go for follow-up tests as the doctor says.

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