Barrett’s esophagus is a condition affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth to the stomach. Barrett’s esophagus is caused by injury to the esophagus from the chronic backwash of stomach contents (like acid and enzymes) that occurs with acid reflux.
Barrett’s esophagus is characterized by a change in the appearance of the esophagus lining from pearly white to a salmon pink color. The diagnosis is confirmed with biopsies that demonstrate changes in the normal esophageal lining cell types. The initial changes in the cell types are described as Metaplasia. As the condition progress, the cells can become more abnormal or Dysplastic. Barrett’s esophagus has long been established as a pre-cancerous condition of the esophagus and, traditionally, its management has been limited to monitoring the condition with endoscopy using the modified Seattle Protocol with the hope that the disease would not progress to cancer.
There are no symptoms specific to Barrett’s esophagus, other than the typical symptoms of acid reflux (or GERD). Heartburn, also known as acid indigestion, is the most common symptom of GERD and usually feels like a burning chest pain which begins behind the breastbone and moves upwards to the neck and throat. Some people experience acidic or bitter taste. Other symptoms of GERD include:
- Chest pain
- Difficulty in swallowing (dysphagia)
- Dry cough
- Hoarseness or sore throat
- Regurgitation of food or sour liquid (acid reflux)
- Sensation of a lump in your throat
DIAGNOSING BARRETT’S ESOPHAGUS:
Modified Seattle Protocol
Presently, the standard of care in the diagnosis and surveillance of Barrett’s esophagus is the modified Seattle Protocol. This protocol calls for 4-quadrant biopsies taken every 2 cms through from the area of the esophagus where Barrett’s disease is evident. Unfortunately, this strategy is based upon random sampling and its reliability in determining the severity of the Barrett’s disease has been called into question. It is well known that 15-20% of patients are under-staged at the time of diagnosis. They may actually have more advanced disease that would be amenable to local therapy.
Volumetric Laser Endomicroscopy (VLE) imaging
Until recently, there has not been a good option for providing a better evaluation of the severity of Barrett’s esophagus. Now, patients with Barrett’s esophagus have the option of undergoing Volumetric Laser Endomicroscopy (VLE) imaging. This technology evaluates the lining of the esophagus in patients with Barrett’s esophagus and provides an in-time microscopic assessment of the lining. Areas of suspicion that are not visible with conventional imaging during a standard endoscopy exam can then be marked with a laser and subsequently biopsied directly. This technology results in the most accurate assessment of patients with this pre-malignant condition.
BARRX RADIOFREQUENCY ABLATION
Barrx Radiofrequency Ablation is a highly-specialized endoscopic technique used to treat patients with Barrett’s esophagus. It utilizes a bipolar radiofrequency energy system designed to deliver precise energy to the surface layer of the lining of the esophagus. If the local conditions are controlled for acid exposure, the tissue layer will re-grow as normal lining of the esophagus. Barrx has been shown to cure Barrett’s disease in more than 90% of patients and has become the standard of care for patients with Low Grade and High-Grade Dysplasia, those with the fastest growing amount of abnormal cells who have the highest risk of developing cancer.
ENDOSCOPIC MUCOSAL RESECTION
Endoscopic mucosal resection (EMR) is a minimally invasive, outpatient endoscopic procedure done under sedation for patients with early-stage Barrett’s esophagus. A flexible tube is inserted into the esophagus via the mouth allowing the endoscopist to remove the affected area of the esophageal lining. This low-risk procedure allows the patient to eat and live normally. Follow up care after either treatment for Barrett’s esophagus is very important. Patients should schedule regular checkups to make sure the Barrett’s disease does not return.