What is Barrett’s Esophagus? | Barrett’s Esophagus Symptoms

Endoscopic views of Barrett’s Esophagus

Symptoms

Barrett’s esophagus alone has no signs or symptoms.  Because of its close connection with Gastroesophageal reflux disease (GERD), symptoms of GERD are often present and include:

• Heartburn – A burning sensation that can run from your throat to the center of your chest
• Regurgitation of sour liquid or food
• Trouble swallowing (If you’re having trouble swallowing, seek care immediately)

 Risk Factors

Based on these risk factors and your medical/family history, your doctor may recommend screening for Barrett’s esophagus.

• Chronic Heartburn/Acid Reflux/GERD: Those who have chronic symptoms (more than five years) are more likely to develop Barrett’s esophagus.
• Age: Barrett’s esophagus is more common in middle-aged and older adults.  55 is the average age of diagnosis.
• Gender: Men are more likely to develop Barrett’s esophagus
• Ethnic Background: White and Hispanic populations are at higher risk than other populations.  Black and Asian populations have a lower risk of developing Barrett’s esophagus.
• Smoking: Current and past smokers are more likely to develop Barrett’s esophagus.

Diagnosis

A doctor may suspect Barrett’s esophagus by reviewing a patient’s medical history, current symptoms, and risk factors. To confirm the diagnosis, doctors perform an endoscopy.

An upper endoscopy is a test that allows a physician to see the inside of the esophagus and stomach using a small lighted tube. After examining the appearance of the esophagus, the doctor may remove small tissue samples (biopsies) to make the diagnosis.

The diagnosis can be challenging due to anatomical differences in patients. Because Barrett’s esophagus doesn’t affect all the tissue in your esophagus, it can also be difficult to detect in some patients.

Three degrees of tissue change

Pathologists, doctors who are experts at examining tissue samples, will help confirm the presence of abnormal, precancerous cell growth (dysplasia) in your esophagus. Samples are often examined by two different pathologists. At least one of them should have special expertise in gastrointestinal disorders.

Pathologists will grade the dysplasia into one of three categories:

• No dysplasia: Barrett’s esophagus is present, but precancerous changes are not found.
• Low-grade dysplasia: Small changes in cells are present
• High-grade dysplasia: Significant changes in cells are present.  High-grade dysplasia is often the precursor to esophageal cancer.

Treatment

Treating Barrett’s esophagus depends on your overall health and extent of dysplasia in your esophagus.

Regardless of the dysplasia amount (if any), the primary goal of treating Barrett’s esophagus is to stop the damage to the esophagus. In most cases, this means eliminating acid reflux.

Foods that can worsen reflux include:

• Acidic Juices like Orange and Tomato Juice
• Coffee / Tea
• Mint
• Alcohol
• Fatty foods

Behaviors that can increase acid reflux:

• Eating right before bed
• Lying down after eating
• Eating very large meals

Lifestyle and Home Remedies to reduce acid reflux:

• Maintain a healthy weight
• Quit smoking
• Raise the head of your bed: Place bricks or blocks under the head of your bed to elevate your head. About six inches is enough. This helps keep the acid in your stomach while you sleep.

Medications

Your doctor may prescribe medications that reduce the amount of acid in your stomach.  These medicines are called proton pump inhibitors, or PPIs. Some of the more common PPIs include:

• omeprazole  (Prilosec, Zegerid)
• lansoprazole  (Prevacid)
• pantoprazole  (Protonix)
• rabeprazole  (AcipHex)
• esomeprazole  (Nexium)
• dexlansoprazole  (Dexilant)

Some of these medications, like omeprazole and lansoprazole, are available over-the-counter.  You should discuss your signs and symptoms with a gastroenterologist if you have frequent heartburn or acid reflux.

 Complications

One potential complication of Barrett’s esophagus is that, over time, the abnormal esophageal lining can develop early precancerous changes. The early changes may progress to advanced precancerous changes, and finally to frank esophageal cancer. If undetected, this cancer can spread and invade the surrounding tissues.

However, progression to cancer is uncommon; studies that follow patients with Barrett’s esophagus reveal that only 0.5 percent of patients develop esophageal cancer per year. Furthermore, patients with Barrett’s esophagus appear to live just as long as people who are free of this condition. Patients often die of other causes before Barrett’s esophagus progresses to cancer.

Monitoring

For most people with Barrett’s esophagus, doctors recommend periodic screening endoscopies to look for signs of cancer.  This approach is called surveillance. Your doctor will help you determine the best level of surveillance based on your condition.

Treatment – No Dysplasia:

• Monitoring Endoscopy: Your doctor may recommend a monitoring endoscopy in one year, and then every 3 years after that if no abnormalities are found.
• GERD Treatment: Controlling acid reflux is important.  Lifestyle changes and medication can help reduce GERD symptoms.  This is helpful when doctors try to locate and grade dysplasia.

Treatment – Low-Grade Dysplasia

• Increased Medication: Those diagnosed with low-grade dysplasia are often asked to increase their dose of acid reducers (PPIs).
• Monitoring Endoscopy: Doctors most often recommend another endoscopy within six months to look for any changes.
• Endoscopic Resection – Endoscopic mucosal resection (EMR) uses an endoscope to remove dysplasia.

Treatment – High-Grade Dysplasia

High-grade dysplasia is often seen as a precursor to esophageal cancer.  Because of that risk, your doctor may recommend the following treatments:

• Endoscopic Resection – Endoscopic mucosal resection (EMR) uses an endoscope to remove dysplasia.  EMR may be a reasonable alternative to esophagectomy in some patients.
• Surgery/Esophagectomy – Complete removal of dysplasia, including all or part of the esophagus.  The remaining part of your esophagus will be attached to your stomach. This type of surgery also carries the highest risk of complications, which should be considered carefully with your doctor.  Your overall health, risk for cancer, and quality of life concerns should all be discussed beforehand.

Complications

Those with Barrett’s esophagus are at increased risk of developing esophageal cancer. The risk is very small, even among those with precancerous changes in the cells lining their esophagus. The vast majority of patients will not develop esophageal cancer.

 FAQ

Is Barrett’s Disease the same thing as Barrett’s Esophagus?

Many people who search for Barrett’s disease are indeed referring to Barrett’s Esophagus.

GERD & Acid Reflux – Symptoms, Treatment, and Relief

What is Acid Reflux?

Acid reflux, or gastroesophageal reflux, is when the liquids in the stomach flow back into the esophagus.

When you eat, food flows through the esophagus and into the stomach.  In between the esophagus and stomach is a circular muscle called the lower esophageal sphincter (LES).  During normal function, the LES relaxes to let food through and then contracts to prevent backflow into the esophagus. When the LES doesn’t function normally, it allows stomach contents to wash back up into the esophagus.

Even in healthy people, stomach acid may occasionally wash back into the esophagus.  These are normally brief periods without symptoms. When acid reflux happens regularly, it can become GERD.

What is GERD?

Acid Reflux/GER becomes GERD (gastroesophageal reflux disease) when it causes injury to the esophagus or bothersome symptoms. Damage to the esophagus is more likely when acid reflux is frequent, happening 2 or more times per week for several weeks.

It’s important to see a doctor if you think you may have GERD. If left untreated, it can lead to other serious problems.

GERD Symptoms

• Heartburn – a burning sensation in your chest, most often after eating.  Heartburn may be worse at night when you lay down.
• Chest pain
• Trouble swallowing
• Regurgitating food or sour liquid
• Feeling like there is a lump in your throat
• Dry Cough
• Bad Breath
• Sore throat
• Hoarseness
• Vomiting

Acid reflux at night may cause:

• Coughing
• Laryngitis
• Asthma
• Sleep disruption

When to see a doctor: If you have chest pain, shortness of breath, or pain in your jaw or arm – seek immediate care.  These could be signs of a heart attack.

Schedule an appointment with a GERD specialist if you:

• Have frequent or severe symptoms of GERD
• Take over-the-counter heartburn medications two or more times per week

GERD Causes

Frequent acid reflux causes GERD, and frequent acid reflux has many causes.

You might have a higher risk of developing GERD if you have any of the following conditions:

• Obesity
• Hiatal hernia (weakening in the diaphragm, causing the stomach to slip through the diaphragm into the chest)
• Pregnancy
• Connective tissue disorders (e.g. scleroderma)
• Gastroparesis (delayed stomach emptying)

Certain lifestyle factors can also increase the risk of acid reflux and GERD:

• Smoking, or frequent exposure to second-hand smoke
• Eating large meals
• Eating late at night or laying down after eating
• Certain types of foods (e.g. fatty, fried, spicy, or dairy foods)
• Drinking alcohol, coffee, or carbonated beverages
• Taking certain medications (e.g. aspirin, antidepressants, blood pressure medications)

GERD Diagnosis

Your doctor may be able to diagnose GERD or acid reflux by examining your medical history, discussing your signs and symptoms, and performing a physical exam. Your doctor might also order tests to rule out other conditions or complications while confirming the diagnosis of GERD, including:

Upper Endoscopy – This is a common procedure used to inspect and evaluate the esophagus. A small, flexible tube with a light and a camera are passed through the esophagus, stomach, and small intestine. This allows your doctor to evaluate any damage to the esophagus caused by acid reflux or GERD.  Your doctor may remove a small tissue sample (biopsy) for further testing.

Bravo pH Monitoring – pH monitoring uses a small monitor attached to your esophagus to measure the acidity in your esophagus over 48 hours. The placement of the monitor does not require a puncture. The monitor transmits data to an external receiver for your doctor to analyze.

High-Resolution Impedance Manometry – Esophageal manometry uses a small tube inserted down your esophagus to measure the muscle contractions, muscle coordination, and the force of the muscle contractions when you swallow.

Complications of GERD and Acid Reflux

Ulcers – Stomach acid in the esophagus can cause sores called ulcers.  These ulcers have the potential to bleed, can be painful, and can make it difficult to swallow. To check for bleeding ulcers, your doctor may recommend a stool sample test called hemoccult, or fecal occult blood test (FOBT)

Stricture – Damage caused by acid reflux can cause the esophagus to scar and narrow. This is called an esophageal stricture. Over time, the esophageal stricture can narrow the esophagus enough to make swallowing food difficult. This is a serious condition that requires treatment. The scar tissue buildup is a result of ulcers that occur and heal over time.

Lung and throat problems – Acid reflux in the throat could lead to irritation or inflammation of the vocal cords or a sore throat. If the acid is inhaled into the lungs, it could cause aspiration pneumonia or symptoms of asthma. If the acid reflux is chronic, it could eventually cause permanent lung damage including pulmonary fibrosis or bronchiectasis.

Barrett’s esophagus – Barrett’s esophagus occurs when the cells in the lower esophagus transform.  The transformation is usually caused by damage to the esophageal lining, most often from chronic acid reflux or GERD. There is a small chance these cells may develop into cancer.  Patients with Barrett’s esophagus should have an upper endoscopy done periodically to look for early signs of cancer.

Esophageal cancer – Barrett’s esophagus is a major risk factor for developing esophageal cancer. The rate of esophageal cancer is on the rise, but relatively few people with GERD develop Barrett’s esophagus and even fewer people with Barrett’s esophagus develop esophageal cancer.

GERD Treatment

Reducing acid in the esophagus is the goal of treatment for GERD and acid reflux. Your doctor will likely recommend lifestyle changes and over-the-counter medications at first.   If these do not work, your doctor may recommend prescription medications or surgery for GERD.

Antacids – Antacids neutralize stomach acid, which may provide short-term relief from acid reflux, but they don’t heal the esophagus. They are available over the counter and include products like Tums®, Maalox®, and Mylanta®.

Histamine antagonists – Histamine antagonists reduce acid production in the stomach. They aren’t as fast-acting as antacids but give longer-lasting relief. They may not be as effective as proton pump inhibitors. Histamine antagonists available over the counter include famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).

Proton pump inhibitors (PPI) – Most people with moderate to severe acid reflux are treated with proton pump inhibitors. These medications stop the stomach from producing too much stomach acid. This can give the esophagus time to heal.

A typical PPI treatment lasts 8 weeks. Using the lowest possible dose of these medications that manage symptoms or prevent complications is the best strategy.

If your symptoms are not managed by a PPI, your doctor may recommend a different PPI or use a stronger dose. Additional testing may be necessary to determine the next course of treatment.

They are available over the counter as products like lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).

Lifestyle changes

Changes in diet and lifestyle may be effective for some people. You may decide to try these before seeking medical treatment for mild symptoms of acid reflux.  If you have severe symptoms, you should be evaluated by a doctor for treatment.

Lose weight – Those who are overweight may see a reduction in acid reflux by losing weight.  Weight loss has numerous other health benefits, including a reduced risk of diabetes and heart disease.

Raise the head of your bed 6-8 inches – Some people who experience nighttime acid reflux may benefit from elevating the head of their bed 6 to 8 inches.   This may help keep stomach acid from entering the esophagus.

Avoid smoking – Saliva helps neutralize stomach acid, but smoking can impact saliva production and the chemical balance.  Smoking can also cause a pressure reduction in the LES muscle that stops stomach acid from entering the esophagus.

Chew gum or use oral lozenges – These may help increase saliva production which may help clear the esophagus of stomach acid.

Avoid fatty foods – Fatty foods take longer to digest in your stomach and cause additional acid production. You can still enjoy lean meats, fish, poultry, etc.

Avoid caffeine – Too much caffeine can relax the LES which keeps stomach acid from entering the esophagus.

Avoid chocolate – The acidity in cocoa powder, caffeine content, and ingredients that may cause loosening of the LES to make chocolate a triple threat. Many people may not see symptoms from eating chocolate in moderation. Chocolate may be more likely to cause issues when combined with other possible triggers like eating right before bed.

Avoid peppermint – Peppermint candies, oil, and teas get much of their distinct flavor from their menthol content. The numbing/soothing effect of menthol can relax the LES and cause acid reflux. Try spearmint as an alternative, which has significantly less menthol content.

Avoid overeating – When you’re stomach is overly full, your LES may have trouble closing completely, which could cause acid reflux.

Avoid eating before bed – Eating while lying down or going to bed soon after eating can increase acid reflux. When upright, your body has gravity’s help to keep stomach acid from entering the esophagus. Lying down makes it easier for stomach acid to flow into the esophagus causing acid reflux. Try to eat two or three hours prior to bedtime.

Avoid tight-fitting clothes – Tight clothing may cause acid reflux by constricting the stomach and forcing acid into the esophagus. Examples include belts, tight pants, shapewear (e.g. Spanx), or other constraining clothing.

Avoid heavy lifting – Strenuous exercises that constrain the abdomen, including heavy lifting or stomach crunches, can cause acid reflux. In general, exercise and weight loss are good for controlling GERD and acid reflux. Your doctor can help recommend the best exercise routine for your goals.

Proton pump inhibitors

Most people with moderate to severe acid reflux are treated with proton pump inhibitors (PPIs). PPIs include omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®), dexlansoprazole (Kapidex®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).

A typical PPI treatment lasts 8 weeks.  Using the lowest possible dose of these medications that manage symptoms or prevent complications is the best strategy.

If your symptoms are not managed by a PPI, your doctor may recommend a different PPI or use a stronger dose. Additional testing may be necessary to determine the next course of treatment.

GERD Surgery

Surgery for GERD is often not necessary due to advances in medical therapy.  However, if your condition does not respond to other therapies, your doctor may recommend a surgical option.

Typically, the goal of GERD surgery is repairing the hiatal hernia or strengthening the lower esophageal sphincter.

Laparoscopic Nissen fundoplication is the most common surgical treatment for GERD.  This procedure wraps the lower part of the stomach around the lower end of the esophagus.

Your doctor will discuss the risks and complications of GERD surgery, which include a sense of bloating/gas, difficulty swallowing, and diarrhea.

Video: What is Heartburn? with Dr. David Pryor Jones

Acid Reflux and GERD Testimonials

“Dr.Ali was wonderful!!! Got me feeling better within no time. Unbelievable difference within the first few days….no more heartburn!” -Yvette

“I was very stressed about my GERD symptoms. After speaking with Dr. Jackson, my anxiety was greatly alleviated. Even though he feels things are ok, his decision to perform an endoscopy really helped me calm down!” -Mary

“Dr. Cunningham is the best. He really helped me with my acid reflux. Thank you, Dr.” -Rose

Heartburn – causes, how to treat.

12/15/2020

A huge number of people suffer from heartburn. According to various sources, from 60 to 70% of the total population of Russia are faced with this disease. So what is heartburn. Heartburn occurs when the acid in the stomach backs up into the esophagus (reflux). Normally, this should not happen. Between the stomach and esophagus is a sphincter valve that must contract. If it does not completely block the passage, the contents of the stomach are partially thrown into the esophagus. The walls of the stomach are lined with an epithelium that tolerates an acidic environment (PH-3), while the walls of the esophagus have a different structure and therefore the acid that enters the walls of the esophagus harms it.

How does heartburn manifest itself?

Approximately 40% of people with heartburn experience a burning sensation in the chest. There are those who feel bitterness in the mouth. Someone has an eructation and even a cough, sore throats …

Important! Sometimes heartburn can masquerade as angina pectoris, or maybe it really is a burning sensation in the chest – this is a heart disease.

Should heartburn be treated?

Heartburn must be treated. If you have symptoms of heartburn, you should contact a gastroenterologist. A persistently irritated esophagus over time can lead to Barrett’s syndrome (a precancerous condition), in 2% of cases it can even lead to cancer. Also, heartburn can be a symptom of stomach ulcers, gallbladder disorders, etc. In addition, heartburn, of course, affects the quality of life. A person is not comfortable playing sports, he cannot afford much from food and drinks.

What causes heartburn?

Coffee, alcohol, especially red wine, hot tea, kefir, citrus fruits, vinegar, fatty foods, spicy foods, overeating. In addition to drinks and food, stressful situations are a provocateur of heartburn.

Do folk remedies help with heartburn?

“Grandmother’s” means in the form of soda, milk, potato broth can be of help only occasionally, if the necessary medicines were not at hand. In fact, they do not cure, but only relieve symptoms. Moreover, they also harm the body. For example, soda contains a lot of sodium, which means that it will harm those suffering from hypertension, plus there is an extra load on the kidneys. Milk contains protein, which will contribute to even more acid production.

How to treat heartburn?

The first rule is that there should be no self-treatment! Patients are prescribed drugs – proton pump inhibitors. The ancestor of drugs was omeprazole. Later, many analogues appeared. All drugs ending in “prozol” reduce the acidity of the stomach. Preparations are prescribed strictly individually, after studying the results of the studies and taking into account the age and state of health of the patient!

If you suffer from heartburn, make an appointment with a gastroenterologist right now! Be healthy!

heartburn gastroenterologist gastrointestinal tract

symptoms, causes and treatment / News / Diagnostic and treatment center MedExpert Saratov / Engels

More than half of the adult population of our planet are familiar with heartburn. A fire inside can ignite after eating, during a sports workout, or when you lie down on the couch. Few people take heartburn seriously – more often it is treated as a problem that just needs to be endured.

Sometimes heartburn is a relatively harmless consequence of eating the wrong food, but it is often a symptom of a serious illness that requires immediate treatment. How to recognize how big the danger is? Answers to important questions about heartburn will be given by an endoscopist of the highest category at the Medexpert LDC, Engels, President of the Association of Endoscopists of the Saratov Region Vasily Vladimirovich Gladkov.

How can I tell if I have heartburn? What sensations does a person experience with this disease?

Gladkov V.V. : Heartburn occurs when aggressive gastric juice containing hydrochloric acid enters the lower esophagus and irritates its mucous membrane. Normally, this does not happen: the esophagus is separated from the stomach by a special valve – the sphincter, which allows food to pass into the stomach, but does not allow it to get back. However, under certain conditions, the valve stops working correctly – then hydrochloric acid is thrown into the esophagus. This causes a real burn, which is felt as a burning sensation. But it is not at all necessary that patients experience a burning sensation, it can be a feeling of fullness, pressure or heat. Heartburn is most likely with increased acidity, but it can also occur with low and normal acidity of gastric juice. According to statistics, from 40 to 60% of the population of developed countries periodically feel heartburn, while 10-20% experience this condition more than once a week. Most often, heartburn occurs about 15-30 minutes after eating.

What are the main causes of heartburn?

Gladkov V.V. : There are several main causes of burning sensation: these are diseases of the gastrointestinal tract. As a rule, heartburn is one of the most common symptoms indicating problems in the digestive system, such as chronic diseases of the gastrointestinal tract (gastric ulcer, chronic gastritis with increased gastric secretion, gastroesophageal reflux). Also, a common cause of heartburn is an unbalanced diet, in particular a passion for sweets and flour products. Especially if sugar-containing foods are combined with protein: the duet causes fermentation. A rare meal, dry food can also stimulate the release of acid. And, of course, overeating. If the holidays follow one after another, or if you eat more than once every three or four hours in small portions, but chew constantly and in large quantities, then the food simply ceases to fit in the stomach and is thrown back because of this.

The cause of persistent heartburn is most likely a serious medical condition. Therefore, the often occurring burning sensation behind the sternum requires urgent intervention: delay in medical care can cost a person health, and sometimes life. In this context, modern and high-quality diagnostics is of great importance. It is important! In some cases, burning behind the sternum is a medical emergency. By the “mask” of heartburn, an attack of angina pectoris and myocardial infarction can be hidden. With timely access to a gastroenterologist and further examination, this terrible disease can be avoided, stopped at any stage.

What methods are available for diagnosing and treating heartburn?

Gladkov V.V. : Diagnosis of heartburn is complex. A thorough examination of the organs of the gastrointestinal tract, namely gastroscopy, can help establish the correct diagnosis. The endoscopic equipment used in the MedExpert LDC is represented by modern video endoscopes operating in the magnification and narrow band imaging (NBI) mode. These modes allow you to detect not only early forms of cancer, but also to see suspicious areas of the mucous membrane (precancerous changes).

Heartburn is not as harmless as many who experience it are used to thinking. If the attacks are repeated systematically, this is a reason to suspect the disease. In such cases, you can not hesitate, because the consequences can be very serious. With frequent or severe heartburn, you should consult a gastroenterologist for a diagnosis and the appointment of suitable drugs.