Barrett's Esophagus Health Article

Definition

Barrett's esophagus is pre-cancerous condition in which normal cells lining the esophagus are replaced with abnormal cells that, in some people, develop into a type of cancer of the esophagus called adenocarcinoma.

Description

The esophagus is a tube 10-13 inches (25-33 cm) long and about 1 inch (2.5 cm) wide that carries food from the mouth to the stomach. Normally, the esophagus is lined with squamous epithelial cells. These cells are similar to skin cells, and look smooth and pinkish-white.

The stomach makes acid to help digest food. A different type of cell that is resistant to acid lines the stomach. These cells look red and velvety. At the place where the esophagus meets the stomach, there is a ring of muscle called the lower esophageal sphincter (LES) muscle that normally keeps acid stomach juices from backflowing into the esophagus. When this sphincter is not working correctly, due to a hiatal hernia or medications or loss of muscle tone, acid material enters the bottom portion of the esophagus. This backflow is called reflux. When reflux occurs frequently over an extended period of time, it is called gastroesophageal reflux disease (GERD).

Acid and digestive enzymes from the stomach irritate the cells lining the esophagus. The result is inflammation of the esophagus called esophagitis, or heartburn. When the cells lining the lower esophagus are frequently exposed to stomach juices, they erode and are replaced with abnormal cells. These new cells are more resistant to stomach acids and, while they look similar to the cells lining the stomach, they are different. Under the microscope, they appear as a pre-cancerous type of cell not normally found in the body.

These new, pre-malignant cells are called specialized columnar cells. Once specialized columnar cells appear, even if the GERD is controlled and the esophagus heals, the abnormal cells remain and are not replaced with normal cells. The presence of patches of these abnormal red cells in the esophagus is known as Barrett's esophagus. The condition is named after British surgeon Norman Barrett (1903-1979).

Cancer that develops from Barrett's esophagus is called adenocarcinoma. It is one of two types of cancer of the esophagus. This type of cancer cannot occur unless the normal cells lining the esophagus have been damaged and replaced with abnormal cells.

Heartburn is an extremely common complaint. About 10% of people in the United States, or more than 20 million Americans, experience severe or frequent symptoms. Of those people who have frequent heartburn for five years or more, 10-20% develop Barrett's esophagus. From this group, approximately 5-10% go on to develop cancer. Overall, people with Barrett's esophagus have a 30-to 125-fold higher risk of developing adenocarcinoma than the general population.