Understanding Barrett's Esophagus

Barrett’s esophagus (BE) or intestinal metaplasia (IM) is a change in the epithelial lining of the esophagus. BE develops as a result of chronic exposure of the esophagus to refluxed stomach acid, enzymes and bile.  
It occurs when a patient’s lower esophageal sphincter or valve no longer closes properly to prevent acid backwash into the lower esophagus. This results in recurrent mucosal injury. Such injury is accompanied by inflammation, and ultimately a cellular change (metaplasia) to a specialized columnar epithelium.¹⁹
Gastroesophageal reflux disease or GERD is a chronic form of heartburn, which according to a Harvard Medical School Report, affects 10% of Americans on a daily basis.³⁵ Acid related diseases are climbing in severity and they are a growing cause of sleep problems and work absences. This indicates an increasing need for early intervention, prevention and therapeutic services for this and other digestive concerns.
Chronic heartburn, being the leading cause of Barrett’s esophagus,³¹ is a digestive concern that requires understanding and about which the public should be made more aware, as it is the beginning of a potential progression toward esophageal cancer.³²
According to the American Gastroenterological Association (AGA), which published a Medical Position Statement on the Management of
Barrett’s esophagus in March 2011, endoscopic eradication therapy – such as radiofrequency ablation (RFA) – for patients with confirmed high-grade dysplasia (advanced precancerous cells) is recommended instead of surveillance or immediate esophagectomy.
For patients with confirmed low-grade dysplasia (less advanced precancerous cells), endoscopic eradication therapy is recommended as a therapeutic option, and it should be discussed as such with patients. For patients with non-dysplastic (early precancerous cells) Barrett’s, the AGA states:

“Although endoscopic eradication therapy is not suggested for the general population of patients with Barrett’s esophagus in the absence of dysplasia, we suggest that RFA, with or without endoscopic mucosal resection (EMR), should be a therapeutic option for select individuals with nondysplastic Barrett’s esophagus who are judged to be at increased risk for progression to high-grade dysplasia or cancer.”

The AGA goes on to reinforce the importance of a…

“…shared decision making where the treating physician and patient together consider whether endoscopic surveillance or eradication therapy is the preferred management option for each individual.”

Incidence

• In a study published in 2005, BE’s prevalence was estimated to affect 3.3 million adults over 50 years of age in the United States.^3,14,36
• The prevalence of BE in the adult population is 0.4% to 1.3%, although recent reports from gastroenterology-selected populations suggest a higher prevalence.⁵

Barrett's and Esophageal Adenocarcinoma

• From 1975 to 2001, the frequency of esophageal adenocarcinoma rose approximately six fold in the U.S. from four to 23 cases per million people. At the same time, the rate of deaths due to this form of esophageal cancer has grown seven fold, from two to 15 deaths per million people.⁴
• Patients with Barrett’s esophagus have an increased risk of developing esophageal adenocarcinoma⁶ at a rate that is 30 to 125 times higher than patients without this condition.⁷
• The American Cancer Society estimates that during 2010, approximately 16,640 new esophageal cancer cases were diagnosed.⁸
• Even with aggressive therapy, the five-year survival rate from adenocarcinoma is only around 17%.⁸

Gastroesophageal Reflux Disease (GERD) and Barrett's Esophagus 

• Approximately 13% of Caucasian men over age 50 who have chronic reflux will develop Barrett’s esophagus.⁴
• In a study conducted by the Veteran Affairs Health Care System and Stanford University, 25% of patients over 50 years old without acid reflux symptoms were found to have Barrett’s esophagus.¹⁴
• GERD is common in the U.S. adult population. Symptoms of acid reflux, including heartburn, occur: 
• Weekly in 18% of U.S. adults¹⁶
• Monthly in almost 44% of U.S. adults¹⁶

"The presence of Barrett’s esophagus is considered to be the primary risk factor for developing esophageal cancer."

Johnston, et al 2008

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