Treatment

Barrett’s Esophagus

This condition is generally caused by having gastric reflux that causes stomach contents to back up into the lower section of the esophagus. Over time, this reflux (GERD) irritates the esophagus, causing part of the lining to be replaced with cells that resemble intestinal cells. As the condition progresses, these cells become increasingly disordered. Long-standing acid reflux disease is common in those who develop Barrett’s Esophagus, which affects about 1 percent of adults in the U.S. Millions of people, 70 percent of adults at some time in their lives, have acid reflux but Barrett’s Esophagus is very rare.

Barrett's esophagus

Barrett’s esophagus (red appearing mucosa in distal esophagus) prior to biopsy demonstrated high-grade dysplasia.

Patients with Barrett’s Esophagus can go on to develop esophageal cancer, which can be deadly. In those with advanced high-grade dysplasia, the risk that the condition will advance to become cancer can be as high as 6 percent a year.

How abnormal cells look under the microscope helps clinicians assess the risk for esophageal cancer. Early Barrett’s Esophagus, low-grade dysplasia, has a low risk of cancer and is handled by periodic surveillance and sometimes biopsies. The greater the dysplasia, the more frequent the monitoring.

In 2009 researchers at Siteman Cancer Center started using radiofrequency ablation, heat generated by radio waves, to treat Barrett’s Esophagus. It can eliminate signs of the potentially cancer-causing disorder and reduce the risk that the disease will progress, as an alternative to surgery. The procedure uses a scope inserted through the mouth to destroy the abnormal tissue. The technique heats the abnormal tissue to destroy it while leaving the deeper layers of the esophagus undamaged.

Patients with the disordered, cellular growth called high-grade dysplasia, associated with more advanced Barrett’s Esophagus, may be eligible for the treatment. In combination with treating the abnormal cells, patients should maintain a regimen of anti-reflux medication to prevent more abnormal cells from developing.

The surgical option is offered to patients with Barrett’s Esophagus found to have severe dysplasia that is resistant to ablation. Surgery 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.