Barrett’s esophagus is a serious complication that appeared on the background of gastroesophageal reflux disease. In addition, Barrett’s esophagus itself, whose signs will be discussed below, is identified as a key risk condition for the further development of esophageal oncology.
What it is
The disease forms over the course of 5 years and is accompanied by acute painful cramps in the chest area. The long, exhausting heartburn leads in such a situation (but not always) to intestinal metaplasia. In this case, the habitual epithelium of the stomach is replaced by the intestinal. This diagnostic report demonstrates a serious condition and therefore many patients are concerned about the question of whether such a disease can be cured.
Note! Doctors say that with the systematic follow-up of the disease and its full therapy, the disease can be preserved.
Normal cells of the mucous membrane of the esophagus is a flat stratified epithelium. These cells are located in several layers and perform a protective role.
To better understand what the disease is Barrett’s syndrome, consider the etiopathogenesis or the mechanism of appearance and formation:
- Gastric juice and bile regularly, over an extended period, enter the esophagus.
- Cells of the stomach and esophagus, in order to adapt to the influence of this acid, proceed to the regeneration and substitution of matters of the intestinal mucosa.
- There are inflammations and erosive-ulcerative changes that develop into dysplasia.
The violation belongs to the ICD class 9 – “diseases of the digestive organs”, code –
What does photo look like?
In the process of endoscopic examination for suspected Barrett’s disease, mucosal lesions are found, usually in the lower part of the esophagus. The broken shell has the appearance of an inflamed ring or a pattern with jagged edges, which have the appearance of purple tongues of various lengths. The affected surface is covered by a special type of tissue, as a result of metaplasia, which provoke a high concern and attention of specialists.
In some situations, due to the constant ingress of acid, the tissue of the esophageal wall proceeds to thicken, which forms a rigid scar that prevents adequate stretching of the esophagus. The lumen in this place narrows, overly complicating the process of swallowing. To block this feature, bougienage is used – a gradual process of stretching (widening the lumen) of the esophagus with a special probe, which is carried out in several sessions.
In the esophagus with such a disease, the redness of the membrane is placed in separate sections and can create a ring over the sphincter. In the center of the red areas may be marked ulceration. Its boundaries are clearly visible, because endoscopists call such a picture "the language of the flame."
Red zones can be placed in separate groups, between them is the usual mucous membrane. What Barrett’s disease looks like can be seen in the photo:
The rebirth of matter itself is not accompanied by certain particular pain symptoms. The syndrome is usually detected during the period of endoscopy. Experts conditionally divide the symptoms of Barrett’s esophagus into typical and atypical.
Typical signs that directly indicate the metaplasia of the esophagus, as a rule, occur already at the moment when the degeneration of the esophagus into oncology begins. The patient notes that:
- Almost can not swallow;
- There is vomiting, which is similar to the coffee grounds or blood mass;
- In feces, black, resinous or bloody blotches appear.
The formation of such signs, as a rule, indicates the fact that a cancer tumor is formed. With the diagnosis of Barrett syndrome, the prognosis can be quite unfavorable. For this reason, experts advise to pay attention to the less painful, but rather obvious symptoms of Barrett’s esophagus:
- Burning pain in the upper region of the stomach.
- Difficulty swallowing.
- A sense of sour taste in the mouth.
- Regular belching and heartburn.
- Increased salivation.
- Erosion of tooth enamel.
Secondary signs of the disease can be expressed after the consumption of excessively fatty and acidic products. Immediately appear pain in the upper part of the stomach, dry cough, which is caused by a feeling of a lump in the throat.
The specialist will be able to diagnose only after he marks in the picture not a glossy fabric of uniform pink color, but walls with bright red zones. Such a symptom directly indicates the formation of Barrett’s esophagus, however, a biopsy must be performed to confirm the diagnostic conclusion.
Changes in the mucous membrane of the esophagus occur under the influence of frequent reflux of the contents of the stomach and intestines with a high concentration of hydrochloric acid in the esophagus. The very process of regular release of not fully digested food from the stomach is called gastroesophageal reflux disease (GERD). The constant influence of hydrochloric and bile acids on the mucous membrane of the esophagus leads to the occurrence of an inflammatory process or esophagitis. Barrett’s disease is found in every tenth patient with reflux-esophagitis.
At the cellular level, the complications of gastroesophageal disease are as follows:
- Hydrochloric acid increases the activity of enzymes that modify cellular proteins and change the style of their connection with other proteins.
- These enzymes act as an internal mutagen, which changes the protein structure of the DNA of cells.
- Growth and division of cells increases.
- There is a process of oppression and dying off of damaged cells in the affected areas of the mucous membrane.
And the causes of gastroesophageal reflux disease are:
- Being in the diet of foods that cause heartburn: coffee, tomatoes, citrus, chocolate, mint.
- Weakness of the lower esophageal sphincter and its inability to restrain gastric contents.
- Reception of drugs – non-steroidal anti-inflammatory drugs and drugs that relax smooth muscles.
- Harmful habits (alcohol, smoking).
- Abdominal obesity, pregnancy – the stomach gets a lot of pressure.
- Excessive acidity of the stomach due to provoking diseases – gastritis, an ulcer.
- Increased pressure in the peritoneum due to constipation.
- Esophageal hernia.
Hernia of the esophagus can be both a cause and a consequence of the disease of Barrett’s syndrome. The esophageal membrane is constantly exposed to injury by hydrochloric acid from the gastric cavity, matter begins to mutate.
Barrett’s esophagus is a disease that occurs throughout life, and often arises due to the following conditions:
- Failure of the lower esophageal sphincter. For this reason, the contents of the stomach enters the esophagus.
- Double reflux – the formation of both GERD and GDR.
- The weakening of the contractile function of the esophagus.
- Increased secretion of hydrochloric acid.
- Smoking, unhealthy diet, excess weight, alcohol, mixed chemotherapy.
Forms of the disease
The presence of dysplasia (progressive transformation of the cell structure) of the epithelium (esophageal membrane) is a characteristic symptom of Barrett’s disease.
Dysplasia of the esophagus is able to wear moderate or severe form.
- The moderate form is distinguished by insignificant changes in the cellular structure;
- Severe form causes an increased risk of formation of Barrett’s esophagus.
There are 3 types of variations of substitution of one type of tissue of the esophagus to another (metaplasia). Given the structures that come to replace normal, the following forms of the disease can be distinguished:
- Cardiac – cells are replaced by epithelial, similar to those located in the zone of entry into the gastric tract;
- Fundamental – cells are replaced by epithelial, similar to those located in the zone of the gastric bottom;
- Cylindrocellular – cells are replaced by goblet structures of the intestinal variety. The most progressive species that precedes a cancer.
25% of situations in patients with Barrett’s esophagus diagnose a mixed form of the disease.
In most situations, the disease is diagnosed by chance. The patient goes to the clinic because of the appearance of the classic symptoms of gastroesophageal reflux disease. Among them, the main symptom of Barrett syndrome is considered to be heartburn, which can accompany a person for many decades of life.
Since Barrett’s disease is considered only a stage in a long-term pathological process that has hereditary conditionality, the definition of a diagnostic conclusion takes into account information on the formation of pathological signs, lifestyle, destructive habits and diets, as well as anamnesis.
If the patient has complained of the presence of heartburn for many years, smokes and systematically takes alcoholic beverages, to a greater extent it can be concluded that he already has Barrett’s syndrome.
When probing the abdominal area, the probable soreness in the navel area, considered a characteristic symptom of Barrett’s disease, is determined.
Laboratory diagnostic methods include:
- Biochemical and clinical blood analysis;
- General urine analysis;
- Analysis of faeces for the presence of hidden blood (if there is a suspicion of bleeding in the hone of the digestive system).
Basic diagnostic methods:
- Endoscopic examination;
- Multiple biopsy (up to 8 biomaterial intakes) and histological examination of the obtained epithelium samples.
Endoscopic examination provides an opportunity to visually assess the status of the esophagus. Histological examination allows to determine the presence, shape and stage of dysplasia or metaplasia.
In the early stages of the disease, metaplasia may not be detected. In this embodiment, patients are required to be examined with an endoscope every 3 years. With weakened dysplasia – 1 time per year. With an elevated stage of dysplasia, it is necessary to conduct a multiple biopsy to detect atypical cells that indicate the formation of a cancer disease.
If the histological examination reveals atypical cells, the patient is sent to x-rays. A contrast agent is introduced into the esophagus, which provides an opportunity to assess the permeability, presence of niches and filling defects.
Timely detected pathology is the key to successful therapy, which provides an opportunity to avoid the formation of a cancer disease in the future.
ICD code 10
Barrett’s disease belongs to class 9 ICD – "diseases of the digestive organs," the code range –
The paramount role in the treatment of Barrett syndrome refers to efforts that aim to stop the reflux of the acidic environment into the esophagus. Among the methods of treatment emit drug, endoscopic, surgical method and popular treatment.
This method assumes:
- Acceptance of antacids (drugs, which reduce the acidity of the gastric tract).
- Acceptance of nonsteroidal anti-inflammatory drugs.
- Lifetime use of proton pump inhibitors (products that reduce the production of hydrochloric acid in the gastric tract).
In the early stages of metaplasia, therapy carried out in time can stabilize the state and significantly slow down the functional and structural changes in the cells, and in some situations lead to a regressive state of the disease.
With the development of metaplastic cylindrical epithelium, drug antireflux treatment is less effective. It has been established that the risk of esophageal oncology from using drugs in this situation is not reduced.
The set of methods that make it possible to influence the epithelium of the esophagus without the implementation of open surgical intervention through the introduction of an endoscope is extensive:
- Endoscopic resection.
- Photodynamic (laser) treatment.
- Thermal ablation
- Radiofrequency ablation.
Barrett’s laser therapy is identical to the methods used in oncology and other diseases. Under the influence of light radiation, aggressive oxygen molecules are activated that are scattered in the dysplasia zone and degraded “abnormal” atypical cells.
Endoscopic resection is currently recognized as the most effective method of treatment. With this treatment, parts of the “wrong” tissue are physically eliminated: they are cut off thanks to a special micronumus, using a loopback grip.
Treatment without surgery
Barrett’s syndrome needs urgent and comprehensive therapy, as it is able to degenerate into an oncological disease. A malignant tumor is much easier to prevent than to try to find the right therapy and save the patient’s life.
The following are the key features of non-operative therapy:
- The diet in Barrett’s syndrome is a significant component of therapy. The diet should be prepared only by a specialist. With such a diet, it is not allowed to eat fried, smoked, spicy, sour, salty. Food should not be hot and not cold – warm. A diet plan for such patients is bound to become a way of life. It should not be stopped after the operation.
- Drug therapy is aimed at reducing the acidity of gastric juice and the elimination of the bacterium Helicobacter Pylori. What drugs to take in Barrett’s syndrome:
- Proton pump inhibitors: Omez, Esomeprazole, Lanzoprazole, Rabeprazole, Pantoprazole.
- Antacids: Maalox, Almagel, Phosphalugel.
- Means for removing Helicobacter Pylori, while for the patient selected individual drugs from the category of antibiotics.
To diagnose this disease and to determine the appropriate course of therapy in the presence of these symptoms in one form or another, you need to contact a specialist.
The feasibility of surgical intervention is considered in the variant, if there was no relief from the use of conservative treatment. In addition, with a complicated course of the disorder, hemorrhages, the peptic structure of the esophagus, and complex organ tissue dysplasia.
The following surgical treatment methods are the most commonly used:
- Fundoplication – plastic cardiac sphincter in order to stop the retrograde movement of gastric contents into the esophagus.
- Removal of part of the body, its lower third.
And besides, less traumatic endoscopic technologies can be used – laser, photodynamic treatment, electro- and argon plasma coagulation, cryodestruction.
Since Barrett’s disease is a rather dangerous disease, it is impractical to follow and use exclusively folk remedies. Useful plants and natural remedies based on them can only be used as part of a comprehensive treatment of the disease. That is, in conjunction with medicinal treatment.
The most common remedies that are used for signs of Barrett syndrome are:
- Potato, carrot, aloe, kalanchoe, cabbage juices (if you wish, you can add a spoonful of honey).
- Broth from raspberry leaves.
- The infusion of medicinal plants – chamomile, calendula, nard, St. John’s wort, sage. It is possible to mix with flaxseeds.
- Mint and centaury.
- Fennel, celandine, valerian.
- Sea buckthorn oil.
It must be remembered that therapy using traditional medicine methods is possible only after consulting with experts.
Possible complications and consequences
The most complex consequences that can cause Barrett’s syndrome are oncology, peptic ulcer and bleeding, narrowing of the walls or an unexpected rupture of an organ, cracks in the epithelium. Oncology in this version is incurable and leads to death.
Stenosis and other non-fatal complications can be eliminated with the help of conservative and surgical therapy. But they bring the patient a lot of painful spasms and discomfort that it is better not to bring them to their appearance.
Specific methods for the prevention of Barrett’s esophagus have not been developed. Monitoring the progression of the disease is an important strategic goal for stopping the oncological transition of cells. Regular monitoring, regular examinations must be combined with a balanced diet and a healthy lifestyle. For the prevention of this disease, a specialist can prescribe remedies that eliminate its root cause – GERD, gastritis, insufficiency of the cardia of the stomach.
Barrett’s esophagus is a complex and dangerous disease, but not a verdict yet. Due to the fact that there is the possibility of death, it is preferable to early contact a specialist. That is, if the patient already has any problems with the work of the digestive tract – they cannot be ignored.
Therapeutic diet and nutrition
As soon as the patient was diagnosed with Barrett’s syndrome, a new stage begins in his life. The subsequent state of health and the degree of his health depends on the correct therapy, adherence to proper nutrition.
Of course, no products will contribute to the reverse transformation of atypical cells. For this reason, the "right food" is not considered the basis for the treatment of this disease. Nevertheless, healthy eating has its own beneficial functions:
- The diet helps eliminate the aggressive effects of certain foods on the esophagus.
- Acidity of gastric juice improves.
- Normalization of digestion and absorption of drugs used in therapy.
- Body weight is normalized.
The principles of nutrition that must be followed in Barrett syndrome:
- Eat food at least 5 times a day, portions must be small, so as not to contribute to overeating.
- In order to reduce the load on the organs of the digestive tract, one should eat boiled, stewed or steamed food. This also applies to fruits and vegetables.
- It is necessary to exclude seasonings, spices, excessively hot and cold food.
- Do not eat food after two hours before bedtime.
- Do not eat foods that provoke pain or discomfort in the abdomen and esophagus.
- Do not use alcohol and tobacco products.
The patient’s menu should include:
- From sweets – marshmallow, marshmallow, marmalade.
- Yesterday’s bread.
- Well ground soups from vegetables.
- Rice, semolina, oatmeal, cooked in water or milk.
- Sour cream, yogurt, milk, butter, cottage cheese, but not kefir – it is excluded from the diet.
- Chicken eggs.
- Fish low-fat varieties.
- Lean meat (chicken, rabbit, beef, veal).
To clarify the diet, it is better to consult with your doctor.
Clinical guidelines 2018
Among the recommendations for the treatment of Barrett’s esophagus are the following:
- Patients with Barrett’s syndrome are required to take proton pump inhibitors with a regimen once a day.
- Acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs do not need to be routinely determined to be treated by a patient with Barrett’s esophagus as an antineoplastic agent. This also applies to other chemoprotective agents due to insufficient evidence base in relation to this disease.
- Patients with nodular enlargements need to prescribe endoscopic epithelium resection. The results of the histological examination required to apply to determine the subsequent treatment.
- Endoscopic ablative treatment does not need to be prescribed to patients with Barrett’s non-plastic esophagus because of the low risk of progression to esophageal adenocarcinoma.
- For patients with a T1a degree of esophageal adenocarcinoma, endoscopic treatment is considered the most preferred type of therapy in relation to not only performance, but also to safety.
The full manual describes 45 clinical guidelines. The full list is available on the website of the American Community of Gastrology.
Dear readers, your opinion is very important to us – so we will be happy to comment on Barrett’s esophagus in the comments, it will also be useful to other users of the site.
Shura, 35 years old:
I always had problems with the digestive tract. Frequent heartburn and throwing the contents into the esophagus led to Barrett’s syndrome. I was very stunned by the diagnosis, because it is a precancer. Immediately appointed an operation to minimize the consequences and remove the risk of cancer. Everything went well, now I am constantly being traced by a doctor, I eat strictly on a diet.
Victoria, 50 years old:
Barrett’s syndrome is a precancerous condition, and with such a diagnosis, it is imperative to observe a doctor, follow a diet and lead a healthy lifestyle. And it is not so important that it is exactly as a treatment that the doctor will offer, the main thing is to follow a diet and lead a healthy lifestyle. It touched me, everything was not very good, the doctors’ forecasts are not the most favorable. Some were sent for the operation, others were not. But the regime in this case saves.