Are You at Risk? Understanding Barrett’s Esophagus

What this condition means for your overall health and risk of esophageal cancer and how you can manage it

By Mia James

Plenty of us have experienced heartburn, that burning pain in your chest, just behind your breastbone. It’s a symptom of acid reflux, a common condition in which stomach acid splashes up from the stomach and into the esophagus—the tube that carries food, liquid, and saliva from the mouth to the stomach. Some people feel better with simple diet and lifestyle changes and taking antacids as needed.

For others, however, heartburn can be the first sign of a more serious health condition. This was the case for Sandi Hix, a 63-year-old registered nurse, wife of more than 44 years, and grandmother from Sandwich, Illinois. For her, frequent heartburn led to a diagnosis of a condition known as Barrett’s esophagus. 

“With Barrett’s esophagus nor­mal cells of the esophagus, called squamous cells, are replaced with intestinal cells called columnar cells,” explains Sushama Gundlapa­lli, MD, a gastroenterologist at Suburban Gastroenterology in Naper­ville, Illinois. “It’s usually the result of ongoing damage to the esophagus from gastroesophageal reflux dis­ease, or GERD,” a chronic digestive disease in which stomach acid or, occasionally, stomach content, flows back into your esophagus.

Dr. Gundlapalli says that as the esophagus is continually exposed to excess amounts of stomach acid, its normal cells change to cells that are more resistant to the acid, which results in Barrett’s esophagus. She says that the cells change in “defense” of the stomach acid. Unfortunately, over time this protective measure raises the risk of esophageal cancer. Risk for Barrett’s increases with age—the average age of diagnosis is 55, says Dr. Gund­lapalli; smoking and obesity also raise one’s risk. Though researchers aren’t certain exactly how common Barrett’s esophagus is, they estimate that it affects 1.6 to 6.8 percent of people in the United States. Men are twice as likely to develop the condition as women, though women are certainly also at risk.1

Barrett’s itself does not cause specific symptoms, so it tends to be diagnosed based on symptoms caused by reflux. These include heartburn, regurgitation, cough, and trouble swallowing. Dr. Gund­lapalli says that some patients also experience “silent reflux,” or reflux without symptoms. This of course can lead to a higher risk of Barrett’s and early cancerous changes, as the disease progresses undetected and causes changes to the cells of the esophagus.

Sandi’s symptoms were typical of reflux. She recalls experiencing troublesome heartburn during her sixth pregnancy. “I slept sitting up on our couch for my last three months of pregnancy just to keep the heartburn under control,” she explains. Though the heartburn improved for a time after her child was born, it never completely went away and worsened over the years.

“I would find myself coughing at night after lying down in bed, from small amounts of acid creeping up,” Sandi explains. The GERD was so strong that acid wasn’t the only thing traveling up her esophagus. “Sometimes, if I ate too late during the day, I would wake at night abruptly with a mouthful of undigested food,” she says.

Sandi clearly had something more going on than the occasional heart­burn some of us experience after too much greasy or spicy food. To find out what was causing the severe reflux, in 2001 she underwent an endoscopy of her upper and lower gastrointestinal (GI) tract. Endos­copy is a procedure in which a doctor uses a flexible tube with a light and camera attached to it to view the digestive tract on a video monitor.

Sandi was diagnosed with Heli­cobacter pylori (H. pylori) bacteria and GERD, as well as gallstones and hiatal hernia, which explained some of the other GI issues she was experiencing. H. pylori is a type of bacteria that causes infection in the stomach and can also lead to peptic ulcers and stomach cancer.

A treatment plan followed. “I had surgery to remove the gallbladder and went on acid-reducing medication for the reflux and a strong antibiotic to get rid of the H. pylori bacteria in my stomach,” Sandi says.

Even with this treatment, Sandi still suffered from GI distress, including esophagitis, or inflammation of the tissues of the esophagus. A couple years later, she was diagnosed with Barrett’s esophagus, which she now manages with medication, lifestyle modifications, and regular screening for early esophageal cancer.

Living with Barrett’s Esophagus

Management of Barrett’s is twofold. It involves controlling the troubling symptoms of reflux and screening for early signs of esophageal cancer.

“Aggressive management of acid reflux,” says Dr. Gundlapalli, “involves lifestyle measures and drugs called proton pump inhibitors to suppress the amount of acid produced by the stomach.” She recommends that patients “avoid eating close to bedtime, avoid being active between the nighttime meal and going to bed, and elevate the head of your bed by at least 30 degrees.” For patients who are overweight, Dr. Gundlapalli says that losing weight with the goal of reaching a healthy body mass index is “the best way to reduce symptoms.” And while certain foods and beverages themselves don’t directly cause reflux, some will aggravate it and are best avoided. These include coffee (even decaf coffee), tea, caffeinated drinks, chocolate, peppermint, fatty foods, and alcohol.

Lifestyle plays a major role in how Sandi manages her health. Though she and her husband still work, she says that stress management and quality of life are their priorities. They travel as much as possible to see their children and grandchildren and stay active by riding bikes, taking walks, and going camping. Sandi’s husband has helped her manage reflex at night by building a platform to elevate the head of their bed. She also takes medication to manage stomach acid (a proton pump inhibitor and over-the-counter Zantac® [ranitidine]), tries not to eat late at night, and avoids acid-producing foods like caffeine and high-fat items.

The good news about cancer risk and Barrett’s esophagus is that the danger isn’t huge. “Progression to cancer is uncommon, with a less than 0.5 percent risk,” says Dr. Gundlapalli. In fact, she explains, “people with Barrett’s live approximately as long as people without and generally die of causes other than esophageal cancer.”

But when it comes to cancer, risk is risk, and no one wants to overlook that. Dr. Gundlapalli says that doctors use the frequency of GERD symptoms to determine which individuals should be screened for precancerous changes to the esophagus. For example, those with intermittent GERD (one to two times per week) who are over 40 and have symptoms three out of 12 months should be screened with an upper endoscopy. Those with proven Barrett’s esophagus are advised to have follow-up endoscopies every three years.

Sandi follows these guidelines and undergoes an upper endoscopy every three years, including tissue sampling of the lining of her esophagus. She also sees an ear, nose, and throat specialist periodically, who performs “a quick in-office scoping of the upper esophagus and larynx to look for areas of concern.”

Sandi stresses the importance of these regular tests and checkups, as they are the only effective way to monitor the health of the esophagus. “There is no way to tell how much damage is being done without looking at the esophagus—and you can’t see it in a mirror!” she says.

Taking Charge of Your Risk

Rather than dwell on the risk of esophageal cancer linked with a diagnosis of Barrett’s, Sandi is being proactive to manage the condition by screening regularly and living each day to the fullest. “My grandfather died from esophageal cancer, and it is not a good way to go,” she says. So she is taking charge by changing what she can and not worrying excessively over what she can’t change. And above all, she recommends, “Find and maintain a positive outlook and allow yourself to be good to yourself as well as to others.”

Reference
1. Definition and Facts for Barrett’s Esophagus. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/ health-topics/digestive-diseases/barretts-esoph­agus/Pages/definition-facts.aspx. Accessed Janu­ary 15, 2016.