What is Barrett’s esophagus?
Barrett’s esophagus is a condition where the normal cell lining (stratified squamous epithelium) of the food pipe (the tube that connects the mouth to the stomach), or a segment of it, is replaced with a different tissue similar to the lining of the intestine. The transformation is called intestinal metaplasia. This occurrence is rare and affects about 1.6 to 3 percent of people. In rare instances and in some individuals, this becomes a pre-cancerous risk.
Why is Barrett’s a concern?
This condition, while mostly without symptoms and could only be an incidental finding and diagnosed during gastroscopy, is of extreme interest to patients who have them and their physicians because Barrett’s poses a slightly increased risk for causing a type of cancer of the esophagus called adenocarcinoma, which could kill if not detected, treated, and followed up regularly. This rare cancer affects one-half percent of people with Barrett’s.
Are Barrett’s and GERD associated?
Yes, GastroEsophageal Reflux Disease (GERD), where the one-way sphincter (valve) between the food pipe and the stomach has become incompetent (loose and wide open), allowing acid and other gastric chemicals to back-up into the lower end of the esophagus, is linked to GERD. It increases the risk for the development of Barrett’s, because those chemicals normally produced by the stomach to aid in food digestion are irritants to the esophagus. This situation also raises the risk for chemical burns, scarring, narrowing, and cancer of the lower end of the esophagus which is connected to the stomach. Unlike the stomach lining, the esophageal lining is not resistant (and is very sensitive) to acids and gastric juices.
What causes Barrett’s esophagus?
Like most diseases, certain groups of individuals are more prone to develop Barrett’s esophagus. GERD, as we have alluded to above, is linked to Barrett’s, with 5 to 10 percent of those with GERD developing Barrett’s. The following are the risk factors: overweight, obesity, smokers, chronic GERD of more than 5 years, long-term GERD patient below 30 and over age 50 and needing medications regularly. Those taking aspirin or other anti-inflammatory drugs and those with Helicobacter pylori infection of the stomach have higher predisposition to Barrett’s. Caucasian males are more prone than other males. In general, males are twice more at risk than females, and so with those whose diet is high in fruits and vegetables. In spite of all this, Barrett’s is still a rare disease.
What is the prevalence of GERD?
In North America, 18.1 to 27.8 percent; Europe, 8.8 to 28.9 percent; Middle East, 8.7 to 33.1 percent; South America, 23 percent; Australia, 11.6 percent; Asia as a whole, 14 to16 percent; and the Philippines, 11 to 15 percent. Clinical observations reveal an increasing prevalence of GERD, worldwide. Some patients with GERD have been found to have hiatal hernia.
What does hiatal hernia do?
The food pipe, which is in the chest, goes down through a hole in the diaphram (the tent-like flat muscle that separates the abdomen from the chest) to connect with the stomach in the abdomen. This hole is called a hiatus. If this hole becomes too large, the stomach, which is normally in the abdomen, could move up to the chest through the hole. If this happens, it is called Hiatus Hernia, and this makes the esophagogastric sphincter loose, allowing gastric contents to back up to the stomach causing reflux esophagitis. Hiatus Hernia is found in only 20-30 percent of those with reflux esophagitis. Severe cases of hiatal hernia will require surgery to reduce the size of the hole to normal and keep the stomach in the abdomen.
What are the symptoms of GERD?
While Barrett’s is mostly asymptomatic, people with GERD usually has heartburn sensation at the pit of the stomach. Others have “chest” pains. Some have belching and sour eructation of food (back-up from stomach to esophagus and throat), especially when they lie down after a meal. And more especially if the meal is spicy hot and alcoholic beverage is consumed. Stomach and food pipe fiberoptic “tele”scope with a lighted videocam (esophagogastroscopy) with tissue biopsy will clinch the diagnosis for Barrett’s and GERD.
What are the complications of GERD?
Besides the discomfort, patients with GERD are treated to prevent potential complications, which include erosion ulcers of the distal esophagus, bleeding, scarring, and constriction (causing swallowing difficulty), and, as stated above, cancer of the esophagus.
What is the treatment?
For Barrett’s, regular follow-up endoscopy and tissue biopsy is the routine, unless the biopsy shows the presence of cancer, in which case, surgery will be the treatment. GERD, which is a risk for Barrett’s, on the other hand, is aggressively treated with medications to reduce the acid secretion in the stomach, with a class of drugs called proton pump inhibitors, like esomeprazole (Nexium), omeprazole (Prilosec) , lansoprazole (Prevacid) and pantoprazole (Protonix), etc. Lifestyle changes will include normal weight maintenance, avoidance of tight clothing and of lying down immediately after a meal, abstinence from smoking and avoidance of alcohol and spicy foods, elevation (6-8 inches) of the head of the bed to reduce reflux of acids from the stomach to the esophagus, and follow-up endoscopy. The side effects of the acid reducer pills will also be managed. In cases of severe tissues changes, any of the following procedures may be used: Radiofrequency ablation, Cryotherapy, Photodynamic therapy, Endoscopic mucosal resection, and Esophagectomy whichever one is clinically indicated.
What is low-acid GERD diet?
Foodwise, the basic principle is to eat natural low-acid foods. Many fruits, vegetables and drinks (soft drinks and fruit juices) have high acidic contents. Some of the low-acid foods include, fish (poached, grilled, baked, not fried), lean poultry (remove skin) and meats (baked, grilled, steamed, not fried), oat meal, brown rice, couscous, potatoes, bananas, water melons, cantaloupes, honeydew, broccoli, green beans, celery, cauliflower, asparagus, egg whites, skip the yolk (which will cause symptoms). As far as the pH of food (measure of acidity, the lower the pH the more acidic) is concerned as a guide, choose foods with pH of 5 and higher to prevent symptoms. You may also Google the pH levels of various food items.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: [email protected]
