Barrett's esophagus can be a silent problem

by Steven Sandberg-Lewis, ND, DHANP

Gastroesophageal reflux disease is the common term for a group of diseases and symptoms caused by the upward flow (reflux) of stomach contents into the esophagus. Common symptoms are a sense of burning or pressure at the breastbone (heartburn) and the regurgitation of fluid or food into the throat. In some cases, there is no typical heartburn. Instead some combination of hoarseness, dry cough, sore throat or shortness of breath will be the symptoms.

GERD is common, occurring in 15-20% of the North American population. It can take many physical forms, which are diagnosed by an upper endoscopy (EGD) and biopsy. An upper endoscopy is a procedure that allows the doctor to directly see the inner lining of the esophagus, stomach and beginning of the small intestine. In addition, biopsy specimens can be taken during the procedure to allow for more detailed diagnosis. The most common finding during an EGD exam of a patient with GERD is a normal esophagus.

The diagnosis of Barrett’s esophagus is suspected when a salmon or red velvety looking esophageal lining is seen through the endoscope. The diagnosis is confirmed when, under the microscope, the type of cell that lines the esophagus has changed from the normal flattened type, called squamous, to a more cube shaped cell, called cuboidal. Barrett’s can progress further into dysplasia (containing precancerous cells) or esophageal cancer, but only in a very small percentage of cases.

The good news is that these more severe complications of GERD are quite rare (0.4-0.5% per year) and effective early treatment often prevents dysplasia and cancer. As long as this doesn’t occur, Barrett’s changes may be one of the body’s best attempts to adapt to the inflammation from chronic unrelenting reflux.

The following factors increase the risk of developing Barrett’s:

·        Caucasian status

·        Male sexual status

·        Age 50 years and older

·        Abdominal obesity

·        Type 2 diabetes

·        Sleeping less than 6 hours/night

·        History of smoking

The following factors are protective to varying degrees against developing Barrett’s:

·        increased vitamin C intake

·        increased folic acid intake

·        increased fiber intake

·        Sleeping 8 or more hours/night

·        taking a proton pump inhibitor

·        taking aspirin

·        taking a statin drug

·        eating less meat, although researchers found this to be of less significance than the other factors

Screening for Barrett’s esophagus and its complications

Screening tests are performed on people who have no known symptoms. This is important because Barrett’s is usually asymptomatic. Early detection can allow for treatments aimed at preventing the progression.

Men with at least two of the other risk factors listed above, should have screening for Barrett’s, even if they do not have heartburn or other symptoms of GERD. This is especially true for white males over 50 years of age, who are obese and/or are current smokers according to the American College of Gastroenterology Guideline, April 2022. Family history of Barrett’s or esophageal adenocarcinoma are also strong indicators for screening. Because females have a very low risk, this test is only performed to diagnose other esophageal problems, but not to screen for Barrett’s.

New technologies may allow more people to be screened. Esoguard is one such device now available in the U.S. It uses a plastic tube that is advanced from the mouth into the lower esophagus, allowing a sampling of the lining cells. The cells can be tested for genetic markers that signal the presence of Barrett’s metaplasia, dysplasia or cancer.

Prevention

Proton pump inhibitors are the most common type of drug used to prevent the progression of Barrett’s to esophageal cancer. In my practice, additional options for protection include treating the cause of reflux whenever possible and using diet, nutritional supplements, and botanical medicines.

My key objectives:

·          control or correct reflux by treating the cause, whenever possible

·          prevent Barrett’s from developing in the esophagus of those with chronic reflux

·          prevent progression to dysplasia in areas already affected by Barrett’s metaplasia.

·          increase differentiation of cells. A differentiated cell has changed in form and matured from being generalized (such as a stem cell) into being more specific in terms of function. Dysplastic esophageal cells are less differentiated than healthy esophageal cells.

·          promote healing of esophagitis

Dietary recommendations include increasing consumption of fresh produce, berries, or berry extracts. More dietary vitamin C, E, folic acid, and riboflavin also increases protection. Research has demonstrated a protective effect for turmeric and green tea against developing a variety of human cancers including esophagus and stomach and breast.

Steven Sandberg-Lewis, ND, DHANP, has been in clinical practice since his 1978 graduation from NUNM. He has been a professor since 1985, teaching a variety of courses but primarily focusing on gastroenterology and GI physical medicine.

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