DEAR MAYO CLINIC:

My local doctor thinks my reflux is actually Barrett's esophagus. Does this mean I might develop esophagus cancer?

ANSWER:

Barrett's esophagus does increase your risk of developing esophageal cancer. But esophageal cancer is rare.

About 7,000 cases of adenocarcinoma, the type of cancer associated with Barrett's esophagus, are diagnosed each year in the U.S.

Less than 10 percent of people who have Barrett's esophagus ever develop esophageal cancer. And, when caught early, this type of cancer can often be effectively treated. The key is to be faithful about seeing your doctor for scheduled check-ups so that if anything changes, it can be dealt with right away.

Barrett's esophagus is a condition in which the color and composition of the cells that line your lower esophagus change.

Here's an easy way to think of it:

When your esophagus is healthy, its pink lining is like a tile floor -- smooth and flat, with square cells. In people with Barrett's esophagus, the lining changes to a salmon color and becomes like shag carpet -- rough, with cells that may be abnormally shaped.

This change in the lower esophageal lining happens because of repeated exposure to stomach acid. The exposure to stomach acid is most often a result of long-term gastroesophageal reflux disease (GERD) -- a chronic regurgitation of acid from your stomach into your lower esophagus.

Because you've been diagnosed with Barrett's, your chances of developing esophageal cancer are higher than normal. Due to the increased risk, it's important that you and your doctor monitor the situation on a regular basis. The American College of Gastroenterology recommends endoscopy once a year for two years when you're first diagnosed with Barrett's esophagus. Endoscopy involves inserting a lighted, flexible tube (endoscope) with a camera on its tip through your mouth and into your esophagus and stomach, so your doctor can examine the esophageal lining. Usually, you'll be sedated.

If no changes are seen after the first two years, then you can wait three years until your next endoscopy. If at any point the lining cells change slightly and appear to become more precancerous (also called low grade dysplasia), it's recommended that you have another endoscopy in six months.

If the cells in the esophagus lining change more significantly and it is determined that there is a high risk of those cells becoming cancerous (high grade dysplasia), you may need to undergo a procedure to destroy those cells. There are four options to treat high grade dysplasia, and sometimes more than one approach is used in combination.

Endoscopic mucosal resection is a procedure that involves lifting the Barrett's lining by injecting a solution under it, applying suction to the affected lining, and then cutting it off. The lining is removed through an endoscope. This procedure is similar to removing a colon polyp. Another option is radiofrequency ablation (RFA), where heat is used to burn the superficial lining of the esophagus. The hope is that healthy cells grow back instead of the unhealthy ones. Another option designed to accomplish the same goal is photodynamic therapy (PDT). A light-sensitizing agent, called porfimer (Photofrin), is injected into your vein 48 hours before PDT. During the procedure, a laser light is passed through an endoscope to activate the porfimer and destroy the tissue in your esophagus that's affected by Barrett's. The fourth option is cryotherapy, in which the Barrett's lining is destroyed by freezing the tissue much like liquid nitrogen freezes warts on the outside skin.

In addition to close monitoring, it's important that you work with your doctor to find ways to control GERD to avoid further damaging your esophagus. This may include avoiding foods that can aggravate heartburn, such as coffee, tea, soda, chocolate, alcohol, mint and high-fat foods. Gum triggers acid production, so I recommend that people with Barrett's esophagus not chew gum. In addition, losing weight if you're overweight, stopping smoking if you smoke, taking antacids or other acid-blocking medications as recommended by your doctor, and elevating the head of your bed to prevent reflux during sleep also can help control GERD.

Keep in mind that having Barrett's esophagus doesn't necessarily mean you will develop esophageal cancer.

Only a minority of patients with Barrett's esophagus progress to cancer.

But it's impossible to predict which patients will be affected by esophageal cancer, so careful monitoring and ongoing treatment of GERD and Barrett's esophagus is essential.

-- Yvonne Romero, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

 

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