9.6 : Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.

To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails inserting a small, flexible tube with a light at the tip to examine the esophagus, stomach, and intestines. Normal tissue appears pale and glossy, while Barrett's affected tissue appears red and velvety. A biopsy is then performed to collect tissue samples for further analysis and to confirm the presence of specialized intestinal cells. A comprehensive biopsy usually includes at least eight samples because Barrett's esophagus may not affect the entire lining. Microscopic examination of these samples determines the presence and degree of dysplasia. Barrett's esophagus is classified into three types: no dysplasia, low-grade dysplasia, and high-grade dysplasia.

The management and treatment of Barrett's esophagus depend on the individual's health and the severity of dysplasia. For those with no or low-grade dysplasia, treatment primarily focuses on controlling GERD symptoms. It may include medications like H2-receptor antagonists and proton pump inhibitors or surgical procedures like Nissen fundoplication and LINX, which strengthen the lower esophageal sphincter. Another option is the Stretta procedure, using radio waves to tighten esophageal muscles.

For patients with high-grade dysplasia, more invasive treatments are necessary, such as endoscopic resection, radiofrequency ablation, cryotherapy, photodynamic therapy, and in some cases, esophagectomy.

Lifestyle modifications are also crucial in managing GERD symptoms and reducing the risk of developing Barrett's esophagus. These include maintaining a healthy weight, avoiding tight clothing, quitting smoking, and avoiding bending or reclining after meals. Elevating the head of the bed can also be beneficial.