Barrett's esophagus (patient information): Difference between revisions
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==Overview== | ==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 55, 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?== | ==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?== | ==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. | [[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]]. | 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?== | ==Who is at highest risk?== | ||
'''Risk factors include:''' | '''Risk factors include:''' | ||
*Gender: Men develop Barrett's esophagus twice as often as women | *Gender: [[Men]] develop Barrett's esophagus twice as often as [[women]] | ||
*Race: Caucasian men are affected more frequently than men of other races | *[[Race]]: Caucasian [[men]] are affected more frequently than [[men]] of other races | ||
==Diagnosis== | ==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. | 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 | 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 miniature camera, into the [[esophagus]]. If the [[tissue]] appears suspicious, the doctor removes several small pieces using a pincer-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?== | ==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 [[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. | 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 options== | ||
Treatment may be important even if you do not feel any symptoms. | Treatment may be important even if you do not feel any [[symptoms]]. | ||
===Lifestyle changes include:=== | ===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 [[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 [[alcohol]] and [[tobacco]] | ||
* Avoiding lying down after meals | * Avoiding lying down after meals | ||
* Losing weight | * Losing [[weight]] | ||
* Sleeping with the head of the bed elevated | * Sleeping with the [[head]] of the bed elevated | ||
* Taking all medications with plenty of water | * Taking all [[medications]] with plenty of [[water]] | ||
===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ===Medications to relieve symptoms and control gastroesophageal reflux include:=== | ||
* [[Antacids]] after meals and at bedtime | * [[Antacids]] after meals and at [[bedtime]] | ||
* [[Cholinergic | * [[Cholinergic]] agents | ||
* [[Histamine H2 receptor | * [[Histamine]] [[H2]] [[receptor]] blockers | ||
* | * Promotility agents | ||
* [[Proton pump inhibitors]] | * [[Proton pump inhibitors]] | ||
===Endoscopic therapies=== | ===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. | 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. | *'''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. | *'''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=== | ===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]] | [[Surgical]] removal of most of the [[esophagus]] is recommended if a [[person]] with Barrett’s esophagus is found to have severe [[dysplasia]] or [[cancer]] an 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== | ==Diseases with similar symptoms== | ||
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==Prevention of Barrett's esophagus== | ==Prevention of Barrett's esophagus== | ||
Diagnosis and treatment of [[GERD]] may prevent Barrett's esophagus. | [[Diagnosis]] and treatment of [[GERD]] may prevent [[Barrett's esophagus]]. | ||
==What to expect (Outlook/Prognosis)?== | ==What to expect (Outlook/Prognosis)?== | ||
Latest revision as of 20:24, 6 February 2018
Template:DiseaseDisorder infobox
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Barrett's esophagus |
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Barrett's esophagus On the Web |
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For the WikiDoc page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Meagan E. Doherty. Amresh Kumar MD [2]
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 55, 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 miniature camera, into the esophagus. If the tissue appears suspicious, the doctor removes several small pieces using a pincer-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 an 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
Where to find medical care for Barrett's esophagus?
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.