Barrett’s Esophagus – causes, symptoms, diagnosis, treatment

Barrett’s Esophagus

The esophagus is the tube-like structure connected with the stomach and used as a way of food.

If any abnormal change occurs in the mucosal layer present in the lower part of the esophagus, and the tissue of the lining of the esophagus takes the place (replaced) with tissue lining of the intestine, this condition is called Barrett’s esophagus.

This change is also known as a premalignant condition because it is associated with a lofty chance of further conversion to Esophageal adenocarcinoma and often deadly cancer.

History and background

Esophagus adenocarcinoma is the sixth most common cause all over the world. And this increases day by day and BE is also one of the main risks of cancer in Europe, it increases by about 8%   per year (about 52,000 patients every year), my estimate of the last 40 years. but unfortunately, only 10% of these were diagnosed.

This is after about 2-7% of adults in countries of the western areas. According to another recent research 0.12-0.13%people are suffering from this disease each year. the advancement of the medical field is proven very helpful in a better understanding of the pathogenesis of this esophageal disease and its progression to adenocarcinoma.

This sickness is columnar metaplasia of the esophagus which causes a change in the histological structure of the gut and it can be seen and tested by using an endoscope. British society of gastrologist finds that, in this esophageal illness, the normal cells are converted into metaplastic columnar Epithelium which is easily seen (visible) in an endoscopic camera. {less than 1 am).

A multidisciplinary group of medical practitioners and physicians from many countries says that this sickness of the esophagus is caused by the change in mucosa columnar cells of the esophagus and for its confirmation, biopsy reports are very important.

Cell types of Barrett’s esophagus

Under microscopic observation, the cell of the digestive system’s sickness (Barrett’s esophagus) is divided into 4 types.

1- nondysplastic.

2- lower-level(grade) dysplasia.

3-high-level(grade)l dysplasia.

4-direct carcinoma.

Why is this called Barrett’s esophagus?

This was named by Norman Barrett (1903-1979) an Australian thoracic surgeon.

In actuality, it is a complicated form of GERD (gastroesophageal reflux disease), in which the tissue lining of the esophagus is changed and gets resemblance with the tissue lining of the intestine.

Symptoms

Barrett’s esophageal sickness does not have any particular indicators (symptoms). Its indicators are related to GERD. Which are as follows…

  •    Pain in chest.
  •     Heartburn.
  •     Acidity.
  •     Vomiting with blood.
  •     Feel ill.
  •     Pain when eating food.
  •     Difficulty in engulfing.
  •     An unpleasant condition, when fluid comes from the mouth.

GERD (gastroesophageal reflux disease)

The stomach produces and stores acid and bile juice in order to digest food.

The acid and start flow backward in the esophagus abnormally, this condition is called acid reflux. By acid reflux, normal cells of the esophagus change and develop in the cell of the intestine, and this causes Barrett’s esophagus.

Approximately 10% of people with GERD develop Barrett’s esophageal disease. It is not necessary that all the time GERD creates Barrett’s esophagus but chronic or deep-rooted GERD can cause this gullet disease (Barrett’s esophagus).

When the part of the stomach is displaced and pokes up through the diaphragm (it is a sheet of muscles that give support and protection). A hernia is helped to keep acid and bile in the stomach. Otherwise, the tissues or cells become abnormal and cause GERD.

Factors that develop GERD

The factors which cause Gastroesophageal reflux disease are the following…

  •     fatty food. And acidic.
  •     Smoking.
  •     Drinking alcohol.
  •     Too much weight.
  •     Over Consumption of tea and green tea.
  •     By using a lot of aspirin and drugs, you have a chance of getting an ulcer.
  •     Hiatus hernia.

Diagnosis

Medical experts diagnose Barrett’s esophagus by starting part (distal, upper) of gut gastrointestinal (GI) endoscopy and by taking a sample for biopsy test. The medical man also diagnoses the related illness (Barrett’s esophagus) while doing tests to detect the reason for a sick person’s gastroesophageal disease (GERD) indicators.

The criteria for the detection of this disease is still disputed. Its theoretical definition is not explained properly, it diagnoses ways. The reason is that it does not explain which type of layer of columnar cells are involved in it. And having a malignant predisposition.

Paul defined it after researching the victims of this esophageal sickness in 1976, he said that more than three sheets of CE lining the distal gullet are present.1- intestinal type,2- functional and gastric fundic. Later 1980, it found the cells of Barrett’s E having a chance of gut adenocarcinoma. It is also mostly related to cancer. After the 1990’s the endoscopy and biopsy test methods were started by doctors. With the advancement of science, these methods are also improved.

Treatment of Barrett’s esophagus

By natural ways:

  •     Avoid smoking.
  •     Eating healthy, fresh and simple food.
  •     While sleeping, I raised my head from the bed.
  •     Relive the acidic reflux to follow a diet.
  •     Treatment by medicines, possible surgery and conventional;

Periodic surveillance of endoscopy

First of all, doctors do gastrointestinal endoscopy with biopsy of the upper part of the gut.to check the condition of disease and chance of cancer development in cells. This approach is called surveillance. Doctors do different types of surveillance according to the condition of patients. If patients have a high grade of dysplasia, then doctors recommend frequent endoscopy as compared to the low grade of dysplasia.

1-radio frequency ablation (RfA)

In this, we use EM rays (radio waves) to kill the abnormal cells while protecting healthy cells by using an endoscope. This process uses electromagnetic radiation to cause the death of cells that are responsible for cancer development in the future (precancerous cells) and cancer cells in the affected tissue.in this process, the endoscope produces heat to kill cancer cells and diseased tissues.

The side effect of radiofrequency ablation

  •     Cuts in the esophagus lining
  •     Pain in chest.
  •     Strictures.
  •     These effects are less common than photodynamic therapy.

2-endoscopic mucosal resection (EMR)

First, we did an ultrasound to check the condition of abnormal cells in this process. And we ensure that the cancer cells are not deeper in the walls of the esophagus. And inject a solution. Then we remove the abnormal cells with the help of an endoscope. Doctors use anesthesia to deaden your food pipe in the neck (throat) to make you more comfortable and relaxed.

A side effect of endoscopic mucosal resection:

  •     Bleeding occurs. Which difficult to handle and also loss of blood.
  •     This process is also combined with photodynamic therapy.

3-endoscopic ablation therapies

In this, different types of techniques are used to demolish the dysplasia cells in the esophagus.

Later these normal cells of the esophagus are developed. This treatment is done at medical centers and outpatient institutes and patients are given regional anesthesia and sedatives.

4-photodynamic therapy

This procedure is done in 24 to 72 hours. The first doctor injected the drug called porfimer, by your arm vein and this drug is a light-activated chemical, which makes the cells too light-sensitive. We use laser light to kill abnormal cells. without damaging the healthy cells by using an endoscope.

Side effects of photodynamic therapy:

  •  The susceptibility of eyes and skin are affected, which remain about 45days (6 weeks)
  •    Burn, swelling, darkness, pain scaring nearby healthy cells.
  •     Coughing, the problem in swallowing, stomach pain, shortness of breath, difficulty in breathing and pain, etc.

Surgery

Surgeries are optional if severe dysplasia or cancer is diagnosed, then surgery is done as soon as possible.

The surgical process is also called esophagectomy. In this process, doctors remove the damaged part by surgery and rebuild this part by using other healthy parts of the stomach or intestine. This takes 7 to 14 days to recover.

Relation of GERD, Barrett’s esophagus and cancer

Gastroesophageal reflux disease is very common in people, especially in the USA.

But only a small percentage of about 10% have developed Barrett’s esophagus and just 1% of patients with Barrett’s esophagus have progressed cancer. Barrett’s esophagus is at most alarmed to increase the risk of cancer not definitely cause it.

 Medicine acclimated (used) for the cure of Barrett’s esophagus

If anyone is suffering from Barrett’s esophagus and gastroesophageal reflux disease, then the doctor recommended his\her acid subdue (suppressing) medicines called proton pump inhibitors(ppts).

These drugs not only prevent further damage to cells but also heal existing damage.

These proton pump inhibitors drugs are

I-Omep-ra-zole. (Prilosec, zegerid)

II-Pant-opra-zole.  (protonic)

III-Rabe-pyrazole. (aciphex)

IV-Lans-pyrazole.  (prevacid)

VI-Declan’s-opera-zole. (Dexilant)

Precaution of Barrett’s esophagus

This disease also progresses to cancer of the esophagus. Due to these main reasons do not try to get bacteria which are Pylori it is a serious cause of infection in the stomach. As a result, all the tissues in the stomach are damaged and ulcers in stomach. Thus, it refers to stomach cancer.To obtain daily base screening.

Doctor’s advice to make a schedule of life when gastroesophageal reflux disease’s symptoms show.

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