Barrett Syndrome (Oesophagus)

What is Barrett Syndrome?

Barrett Syndrome is a modified complicated form of gastro-esophageal reflux disease or GERD. In this condition the tissue lining of the esophagus is altered and resemble as the lining of the intestine. It is observed that almost 10% of chronic sufferers of GERD is developed Barrett Syndrome.

Therefore, The symptoms almost have the similar types of symptoms as in case of GERD, but some cases, it may appear as asymptomatic condition. In serious cases Barrett Syndrome has increased the risk of adenocarcinoma, which is a life threatening cancer progressed in esophagus, though the cancer is common in esophageal cancer, but chance of development of the condition is rare. Therefore, it is advisable to a routine checkup of esophagus in case of occurrence of the Barrett Syndrome. Routine checkup helps to screen the adenocarcinoma for better treatment prognosis. ^(1,2)

Symptoms

The alteration of the tissue structure in the lining of the esophagus is usually asymptomatic. The common sign and symptoms are related to GERD, which include:

• Recurrent heartburn
• Swallowing difficulty
• Chest pain is very occasional

Even no symptoms are developed for Barrett Syndrome.

In the following symptomatic development need immediate medical attention, which include chronic heartburn for more than 5 years suffering history. This condition leads to Barrett syndrome. In addition to Barrett syndrome following conditions require medical help:

• Severe, sudden chest pain, which may be the indication of cardiac attack.
• Deglutition become very difficult and patient cannot swallow any solid food.
• Blood vomiting
• Tarry or black colored stool
• Bleeding during passage of stools.

Cellular alteration

The healthy anatomy of the esophagus is demonstrated as an easy way to move the food from mouth to stomach, which is made up of pinkish-white, squamous tissue, as their arrangement is flat and smooth cells base. This lining is not comprised mucous coating which has a protective action against acid, as it present in the stomach. Therefore, reflux of acid and other enzymatic secretion can cause irritation of the esophagus wall, heartburn or chest pain is developed.

But chronic untreated condition leads to cellular damage of the lining, specifically at the rare portion of the esophagus. Gradually cell structured is changed and the mucus-secreting cells, which are red in color is replaced to the esophagus lining. This alteration indicates Barrett syndrome. ^{(2, 4)}

Causes

The proper cause of the development of the Barrette syndrome is not known, but most of the cases it is associated with chronic GERD. In GERD, the acid flow in backward direction means from the stomach to the esophagus. In the chronic condition, it stimulates to anatomical alteration of the lining of the esophagus and red colored mucus secreting cells are found in the esophagus wall and that is an indication of Barrette syndrome. ⁽²⁾

Acid Backing Up

Diagnosis

Diagnostic test for Barrette syndrome is mainly types:

Endoscopy

If patients complain for long term heartburn, then endoscopy is a primary diagnostic measure. In this test a narrow tube which contains a high powered tiny camera is entering into the mouth and via throat it extended to the esophagus. The images are displayed on computer screen. A pale and glossy esophagus image is obtained in normal healthy people, but that is altered and becomes red and velvety in Barrette syndrome.

Biopsy

Any suspected findings and the extend of alteration is required to conduct biopsy of the esophageal cells.

The doctor use to remove a small tissue sample (biopsy). The biopsy can be examined to determine the degree of tissue change. The degree of alteration is measured by dysplasia.

No dysplasia means pancreas involvement is nil.

Low- grade dysplasia means a small alteration in the pancreatic cells.

High-grade dysplasia contains vast alterations and considered the precancerous condition of the esophagus. ⁽²⁾

Treatment

A wide range of treatment options is available, but selection of treatment option depends to proper diagnosis and degree of cellular changes observed.

Medication

Doctor prescribed proton pump inhibitors or H2-receptor antagonists to control the excessive acid secretion and also provide the relief of related symptoms. No dysplasia or Low- grade dysplasia

The following treatment options are mainly applied for High-grade dysplasia or cancerous growth.

Radiofrequency ablation (RFA)

In this treatment, radio waves are provided to the abnormal cells to stop growth and destroy them. This is inserted through the endoscopy tube. This is applied very cautiously, so that associated healthy tissue should not be affected by radiation.

Photodynamic therapy (PDT)

In this treatment, laser rays are applied to kill the abnormal cells in the lining of the esophagus. To target only affected cells, Photofrin this drug is provided to make the cells photo-sensitive (light-sensitive).

Cryotherapy

In this therapy, cold nitrogen or carbon dioxide gas is sprayed through the endoscopic tube and applied freezing technique cause abnormal cell necrosis.

Surgical intervention

Nissen fundoplication

Surgical modification helps to enfold the apex of the stomach around the outside of the lower esophageal sphincter.

Linx

In this process a medical device known as linx is inserted around the lower esophagus. This device contains a number of tiny metal beads that cause magnetism to avoid leaking of the stomach content into esophagus.

Stretta procedure

In this process Radio waves are applied to support the stomach muscles and reduces reflux of the stomach contents. ^{(1, 2, 4)}

References

1. Carmella Wint and Elizabeth Boskey, (2016); Barrett’s Esophagus; Retrieve from: http://www.healthline.com/health/barretts-esophagus#Overview1
2. Mayo Clinic Staff (2014); Barrett’s esophagus; Retrieve from: http://www.mayoclinic.org/diseases-conditions/barretts-esophagus/basics/definition/con-20027054
3. Mark H Johnston, Barrett Esophagus Treatment & Management; Retrieve from: http://emedicine.medscape.com/article/171002-treatment
4. Barrett’s oesophagus; Retrieve from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/barretts-oesophagus