View source for Barrett's esophagus (patient information)

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{{DiseaseDisorder infobox |
 Name = Barrett's esophagus |
 ICD10 = {{ICD10|K|22|7|k|20}} |
 ICD9 = {{ICD9|530.85}} |
 ICDO = |
 OMIM = 109350 |
 MedlinePlus = 001143 |
 eMedicineSubj = |
 eMedicineTopic = |
 DiseasesDB = 1246 |
}}
{{Barrett's esophagus (patient information)}}
'''For the WikiDoc page for this topic, click [[Barrett's esophagus|here]]'''
{{SI}}

{{CMG}}; '''Assistant Editor-In-Chief:''' Meagan E. Doherty. {{AMK}}

==Overview==
[[Barrett’s esophagus]] [[is]] [[a]] [[condition]] [[in]] [[which]] [[the]] [[tissue]] [[lining]] [[the]] [[esophagus]]-the [[muscular tube]] [[that]] [[connects]] [[the]] [[mouth]] [[to]] [[the]] [[stomach]] [[is]] [[replaced]] [[by]] [[tissue]] [[that]] [[is]] [[similar]] [[to]] [[the]] [[lining]] [[of]] [[the]] [[intestine]]. [[This]] [[process]] [[is]] [[called]] [[intestinal]] [[metaplasia]].

[[No]] [[signs]] [[or]] [[symptoms]] [[are]] [[associated]] [[with]] [[Barrett’s esophagus]], [[but]] [[it]] [[is]] [[commonly]] [[found]] [[in]] [[people]] [[with]] [[gastroesophageal reflux disease]] ([[GERD]]). [[A]] [[small]] [[number]] [[of]] [[people]] [[with]] [[Barrett’s esophagus]] [[develop]] [[a]] [[rare]] [[but]] [[often]] [[deadly]] [[type]] [[of]] [[cancer]] [[of]] [[the]] [[esophagus]].

[[The]] [[average]] [[age]] [[at]] [[diagnosis]] [[is]] [[50]], [[but]] [[determining]] [[when]] [[the]] [[problem]] [[started]] [[is]] [[usually]] [[difficult]]. [[Men]] [[develop]] [[Barrett’s esophagus]] [[twice]] [[as]] [[often]] [[as]] [[women]], [[and]] [[Caucasian]] [[men]] [[are]] [[affected]] [[more]] [[frequently]] [[than]] [[men]] [[of]] [[other]] [[races]]. [[Barrett’s esophagus]] [[is]] [[uncommon]] [[in]] [[children]].

==What are the symptoms of Barrett's esophagus?==
[[Barrett's esophagus]] [[itself]] [[does]] [[not]] [[cause]] [[symptoms]]. [[The]] [[acid]] [[reflux]] [[that]] [[causes]] [[Barrett's esophagus]] [[results]] [[in]] [[symptoms]] [[of]] [[heartburn]].

==What are the causes of Barrett's esophagus?==
[[Irritation]] [[of]] [[the]] [[lining]] [[of]] [[the]] [[esophagus]] [[by]] [[stomach]] [[acid]] [[can]] [[lead]] [[to]] [[Barrett's esophagus]]. [[The]] [[irritation]] [[is]] [[caused]] [[by]] [[stomach acid]] [[that]] [[leaks]] [[and]] [[moves]] [[back]] [[up]] [[the]] [[gastrointestinal tract]]. [[This]] [[is]] [[commonly]] [[known]] [[as]] [[gastroesophageal reflux]] ([[GERD]]) [[and]] [[it]] [[can]] [[cause]] [[heartburn]].

[[Barrett's esophagus]] [[is]] [[more]] [[common]] [[in]] [[men]] [[than]] [[women]]. [[You]] [[have]] [[a]] [[greater]] [[risk]] [[for]] [[this]] [[condition]] [[if]] [[you]] [[have]] [[frequent]] [[and]] [[long-standing]] [[GERD]].

==Who is at highest risk?==
'''Risk factors include:'''
*[[Gender]]: [[Men]] [[develop]] [[Barrett's esophagus]] [[twice]] [[as]] [[often]] [[as]] [[women]]
*[[Race]]: [[Caucasian]] [[men]] [[are]] [[affected]] [[more]] [[frequently]] [[than]] [[men]] [[of]] [[other]] [[races]]

==Diagnosis==
[[Because]] [[barrett’s esophagus]] [[does]] [[not]] [[cause]] [[any]] [[symptoms]], [[many]] [[physicians]] [[recommend]] [[that]] [[adults]] [[older]] [[than]] [[40]] [[who]] [[have]] [[had]] [[GERD]] [[for]] [[a]] [[number]] [[of]] [[years]] [[undergo]] [[an]] [[endoscopy]] [[and]] [[biopsies]] [[to]] [[check]] [[for]] [[the]] [[condition]].
[[Barrett’s esophagus]] [[can]] [[only]] [[be]] [[diagnosed]] [[using]] [[an]] [[upper gastrointestinal (GI) endoscopy]] [[to]] [[obtain]] [[biopsies]] [[of]] [[the]] [[esophagus]]. [[In]] [[an]] [[upper]] [[GI]] [[endoscopy]], [[after]] [[the]] [[patient]] [[is]] [[sedated]], [[the]] [[doctor]] [[inserts]] [[a]] [[flexible]] [[tube]] [[called]] [[an]] [[endoscope]], [[which]] [[has]] [[a]] [[light]] [[and]] [[a]] [[mniature]] [[camera]], [[into]] [[the]] [[esophagus]]. [[If]] [[the]] [[tissue]] [[appears]] [[suspicious]], [[the]] [[doctor]] [[removes]] [[several]] [[small]] [[pieces]] [[using]] [[a]] pincher-like [[device]] [[that]] [[is]] [[passed]] [[through]] [[the]] [[endoscope]]. [[A]] [[pathologist]] [[examines]] [[the]] [[tissue]] [[with]] [[a]] [[microscope]] [[to]] [[determine]] [[the]] [[diagnosis]].

==When to seek urgent medical care?==
Call your health care provider if [[heartburn]] persists for longer than a few days, or you have pain or difficulty swallowing.

Call your provider if you have been diagnosed with Barrett's esophagus and your symptoms get worse or do not improve with treatment, or if new symptoms develop.

==Treatment options==
Treatment may be important even if you do not feel any symptoms.

===Lifestyle changes include:===
* Avoiding dietary fat, chocolate, caffeine, and peppermint because they may cause lower esophageal pressure and allow [[stomach acid]] to flow backwards
* Avoiding alcohol and tobacco
* Avoiding lying down after meals
* Losing weight
* Sleeping with the head of the bed elevated
* Taking all medications with plenty of water

===Medications to relieve symptoms and control gastroesophageal reflux include:===
* [[Antacids]] after meals and at bedtime
* [[Cholinergic agents]]
* [[Histamine H2 receptor blockers]]
* [[Promotility agents]]
* [[Proton pump inhibitors]]

===Endoscopic therapies===
Several endoscopic therapies are available to treat severe [[dysplasia]] and [[cancer]]. During these therapies, the Barrett’s lining is destroyed or the portion of the lining that has [[dysplasia]] or [[cancer]] is cut out. The goal of the treatment is to encourage normal esophageal tissue to replace the destroyed Barrett’s lining. Endoscopic therapies are performed at specialty centers by physicians with expertise in these procedures.
*'''Photodynamic therapy (PDT).''' PDT uses a light-sensitizing agent called Photofrin and a laser to kill precancerous and cancerous cells. Photofrin is injected into a vein and the patient returns 48 hours later. The laser light is then passed through the endoscope and activates the Photofrin to destroy Barrett’s tissue in the esophagus. Complications of PDT include [[chest pain]], [[nausea]], sun sensitivity for several weeks, and esophageal strictures.
*'''Endoscopic mucosal resection (EMR).''' EMR involves lifting the Barrett’s lining and injecting a solution under it or applying suction to it and then cutting it off. The lining is then removed through the endoscope. If EMR is used to treat cancer, an [[endoscopic ultrasound]] is done first to make sure the cancer involves only the top layer of esophageal cells. The ultrasound uses sound waves that bounce off the walls of the esophagus to create a picture on a monitor. Complications of EMR can include bleeding or tearing of the esophagus. EMR is sometimes used in combination with PDT.

===Surgery===
Surgical removal of most of the esophagus is recommended if a person with Barrett’s esophagus is found to have severe [[dysplasia]] or [[cancer]] and can tolerate a surgical procedure. Many people with Barrett’s esophagus are older and have other medical problems that make surgery unwise; in these people, the less-invasive endoscopic treatments would be considered. Surgery soon after diagnosis of severe [[dysplasia]] or [[cancer]] may provide a person with the best chance for a cure. The type of surgery varies, but it usually involves removing most of the esophagus, pulling a portion of the stomach up into the chest, and attaching it to what remains of the esophagus.

==Diseases with similar symptoms==
*[[Esophagitis]]
*[[GERD]]<ref>http://www.wrongdiagnosis.com/b/barretts_esophagus/misdiag.htm</ref>

==Where to find medical care for Barrett's esophagus?==
[http://maps.google.com/maps?q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|map+top+hospital+Barrett's esophagus}}}}&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=wl Directions to Hospitals Treating Barrett's esophagus]

==Prevention of Barrett's esophagus==
Diagnosis and treatment of [[GERD]] may prevent Barrett's esophagus.

==What to expect (Outlook/Prognosis)?==
An increased risk of [[esophageal cancer]] is present. Follow-up [[endoscopy]] to look for [[dysplasia]] or [[cancer]] is often advised.

==Sources==
*http://www.nlm.nih.gov/medlineplus/ency/article/001143.htm
*http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/#diagnosis
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[[Category:Patient information]]
[[Category:Gastroenterology patient information]]

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