Barrett’s Esophagus: A Hidden Risk for Esophageal Cancer

Most of us have experienced acid reflux. Eating a large, rich meal or enjoying an excessive amount of your favorite alcoholic beverage can trigger the discomfort caused by stomach acid escaping in the wrong direction – into your esophagus and throat.

An occasional bout of acid reflux may be uncomfortable, but it doesn’t present a threat to your overall health. But if you are experiencing it on a regular basis – several times a week – you may have gastroesophageal reflux disease (GERD), which can damage your throat, voice and lungs. It also can lead to Barrett’s esophagus, a condition that increases your risk for esophageal cancer.

Barrett’s Esophagus: Healing Gone Awry

To understand Barrett’s esophagus, first consider how your esophagus and stomach work together to help you digest food. After you chew and swallow your food, it travels down your esophagus and into your stomach, where powerful acids go to work.

In between your stomach and esophagus is the lower esophageal sphincter, a muscle that acts as a gatekeeper to prevent food and acid from going back into the esophagus. If that muscle is weakened, your stomach contents can travel in the wrong direction and work their way into your esophagus, throat and mouth.

With stomach acid repeatedly burning the lining of your esophagus, your body reacts by trying to heal and protect the area. Researchers aren’t sure why, but in some cases, your body will actually change the cells in the lining of your esophagus to make it more like the lining of your stomach and intestines – which protects it from acid damage.

Unfortunately, this protective mechanism puts you at risk for a life-threatening health condition.

Barrett’s and Cancer

Throughout your life, your body is constantly replacing cells that die. Every time this happens, there is a small chance that the new copy will be abnormal. And there is a small chance the abnormal cell (called dysplasia) could lead to cancer. But with Barrett’s esophagus, the chance of creating an abnormal cell is even greater because of the way your body is acting to protect the area. Barrett’s is defined in four stages:

• Barrett’s metaplasia: In this early stage, no abnormal cells have been created and there is low cancer risk.
• Barrett’s with low-grade dysplasia: A small number of abnormal cells are present, though cancer risk remains low.
• Barrett’s with high-grade dysplasia: There are many abnormal cells, with significant cancer risk.
• Barrett’s with cancer: The abnormal cells have become cancerous.

Esophageal cancer is a rare disease that is challenging to treat because it is often not detected until it becomes more advanced and triggers notable symptoms, including difficulty swallowing, unexplained weight loss, vomiting with streaks of blood, and blood in mucus while coughing. Unfortunately, it is difficult to predict whether Barrett’s will lead to cancer, which occurs in about 2 percent of cases each year.

Treating Barrett’s Esophagus

Barrett’s esophagus is usually diagnosed through an endoscopy, which uses a thin, flexible tube mounted with a tiny camera and tools. The procedure looks for signs of tissue changes and collects small tissue samples for evaluation. Treatment for Barrett’s could take several forms, depending on where you are with the condition.

The first objective will be to prevent further damage by eliminating GERD. This could be done through lifestyle changes, medications and, potentially, surgery to reinforce the valve between your stomach and esophagus. GERD can also be caused by a hiatal hernia, a common condition in which part of your stomach bulges into your chest. The condition can be repaired with surgery.

Your doctor will also monitor your condition regularly to watch for any changes that suggest cancer is more likely to occur. If the condition progresses, your doctor may recommend treating Barrett’s. This is done with an endoscopic procedure that burns the lining of your esophagus to encourage it to return to normal and prevent cancerous cells from forming.

If the condition advances to cancer, surgery can be used to remove small, early-stage tumors before they have a chance to grow. Otherwise, surgery will likely be used to remove the esophagus and part of the stomach. A new esophagus would be created, using stomach tissue.

Fortunately, esophageal cancer is rare. And the best way to protect yourself against it is to get control of GERD.