The esophagus is the muscular tube that propels your food from your mouth into your stomach. The main role of the stomach is to grind up food and then to use acid to assist in the digestion of food. The stomach lining is specifically designed to resist the damaging effects of this acid. Acid is not normally found in the esophagus. A tight muscular band in the lower part of the esophagus (lower esophageal sphincter) normally prevents the acid in the stomach from passing back into the esophagus. Because of the different roles of the stomach and the esophagus, the cells lining the stomach and the esophagus are completely different. When the cell types that are normally found in the stomach are also found in the esophagus, this condition is called "Barrett's esophagus".

Although many people with Barrett's esophagus have heartburn, Barrett's esophagus can only be detected if you have an Upper GI endoscopy. An Upper GI endoscopy involves placing a small flexible tube called an ENDOSCOPE into your mouth and down into your stomach through the esophagus. The endoscope is equipped with a small video camera allowing the doctor to see the inside of the esophagus and stomach. The normal lining of the esophagus is usually a slightly different color and texture than the normal lining of the stomach. The lining of the esophagus appears pink and the cells are flat (squamous epithelium) while the lining of the stomach appears as a much deeper red and consists of tall rectangular cells (columnar epithelium). When the physician finds "stomach-like" lining present in the esophagus, you probably have "Barrett's esophagus". Nevertheless, your physician will biopsy this area of the esophagus and a pathologist will look under the microscope for the specific cell type that characterizes Barrett's esophagus.

Although the exact cause of Barrett's esophagus is unknown, most people who develop Barrett's esophagus have a long standing problem with moderate to severe heartburn (also known as gastroesophageal reflux disease or GERD). Heartburn is caused by acid backing up into the esophagus and irritating the lining of the esophagus. Since the stomach lining is designed to resist acid and the esophagus is not, researchers believe that the development of Barrett's esophagus may actually be a protective mechanism so the esophagus is not damaged by the acid "refluxing" up into the esophagus.

By itself, Barrett's esophagus causes no problems and the development of Barrett's esophagus may actually serve to lessen heartburn symptoms. On the other hand, in some people, Barrett's esophagus may be a precursor to the development of esophageal cancer. In fact, the type of esophageal cancer found in people with a history of Barrett's esophagus is rising more quickly in the United States than any other type of cancer. About 10% of people with Barrett's esophagus will eventually develop esophageal cancer. Put another way, your risk of developing esophageal cancer if you have Barrett's esophagus is about 1% per year. Other potential complications of Barrett's esophagus include:

• esophageal stricture (or narrowing of the esophagus)
• esophageal ulcer.

Most people with Barrett's esophagus have had heartburn for many years. In fact, some people with Barrett's esophagus may have very little or no heartburn now but in the past, they probably had severe or frequent heartburn. In addition to longstanding heartburn, other "risk factors" for acquiring Barrett's esophagus include:

• age greater than 55 y/o
• white race
• male sex

People with a long history of gastroesophageal reflux or people with other risk factors for Barrett's esophagus should have an Upper GI endoscopy to look for evidence of Barrett's esophagus. Remember, the only way to detect Barrett's esophagus is to have an Upper GI endoscopy.

There are two main types of esophageal cancer. Cancers arising from the cells that normally line the esophagus lead to squamous cell cancer of the esophagus. Cancers arising from columnar cells (Barrett's esophagus) lead to adenocarcinoma of the esophagus. Squamous cell cancer of the esophagus is much more common than adenocarcinoma of the esophagus.

The exact role of acid reflux in the development of esophageal cancer is unknown. Nevertheless, if you have heartburn or your endoscopy revealed an inflamed esophagus, medications that can prevent acid reflux are recommended. In addition, when Barrett's esophagus is detected, regular surveillance of the esophagus with repeat Upper GI endoscopy is recommended. The frequency for repeat endoscopy is determined by:

• the length of Barrett's esophagus present as well as
• the degree to which the cells are abnormal.

There is a predictable transition from a normal cell to a cancer cell. The closer in appearance your Barrett's esophagus cells are to the cancer cells, the more frequent the surveillance.

If the cells begin to look worrisome, treatment of the Barrett's esophagus to prevent or remove early esophageal cancer may be needed. Surgery has been the usual therapy but newer methods to remove the Barrett's esophagus using an endoscope inside the esophagus are under investigation.

Your doctor will take all the special circumstances of your individual situation under consideration and decide on the proper frequency for repeat upper GI endoscopy. Usually, the interval varies anywhere between 6 month and 3 years.

Your physician here at Dubuque Internal Medicine will be happy to answer any of your questions.