Barrett's esophagus is a mucosal change in the lower section of the esophagus. The risk of carcinoma for patients with Barrett's oesophagus is significantly increased. As reflux disease is considered to be a cause of Barrett's oesophagus, patients with prolonged heartburn should undergo endoscopy.
Here you will find all the important information as well as qualified Barrett's esophagus specialists and centers.
Barrett's oesophagus is the detection of a specific mucous membrane in the lower section of the oesophagus (metaplastic Barrett's epithelium). It occurs more frequently in patients with reflux disease.
These mucosal changes can be circular (the entire circumference of the esophagus) or tongue-shaped. An arbitrary distinction is made between a short (short-segment; < 3 cm) and a long (long-segment; > 3 cm) Barrett's esophagus.
Barrett's esophagus is twice as common in men as in women. In the literature, it is diagnosed in approx. 5% of the normal population (strong fluctuations, 1-20% depending on the study).
The position of the oesophagus and stomach © SciePro | AdobeStock
Gastro-oesophageal reflux disease is considered to be one of the causes of Barrett's oesophagus. However, heredity is also described as a cause. The risk of esophageal cancer for patients with Barrett's mucosa (intestinal metaplasia of the distal esophagus) is significantly increased.
The incidence of adenocarcinoma of the oesophagus is increasing, which is why Barrett's oesophagus is receiving a great deal of attention.
In addition to chronic reflux disease,risk factors include
Many patients with Barrett's oesophagus suffer from heartburn. However, around 40% of patients have no reflux symptoms and are therefore asymptomatic. Barrett's oesophagus is therefore only discovered by chance.
The diagnosis is made endoscopically and histologically (removal of tissue samples). New endoscopic techniques may improve the diagnosis. These include
Patients with prolonged heartburn should therefore undergo endoscopy. Hoarseness, coughing and asthma can also be symptoms of reflux disease. They should be clarified by endoscopy if necessary.
Left: Healthy stomach. Right: Reflux disease, in which stomach acid flows back into the oesophagus © bilderzwerg | AdobeStock
Alarm symptoms are
They make an endoscopy absolutely necessary, as in these cases a malignant tumor due to Barrett's oesophagus is possible.
Once a diagnosis of Barrett's esophagus has been made, a biopsy must be performed. This can clarify whether cells are already altered in the sense of so-called dysplasia and whether there is a possible precancerous stage.
The treatment of Barrett's oesophagus depends on the symptoms and whether altered cells (dysplasia) have already been detected during the endoscopy.
In a symptom-free patient without dysplasia, a regular endoscopic check-up every 3-4 years is currently recommended. The German Society for Digestive and Metabolic Diseases (DGVS) advocates this.
Patients with heartburn and without dysplasia should be treated with a so-called acid blocker (proton pump inhibitor).
However, if dysplasia is detected in Barrett's oesophagus, so-called mild dysplasia should be monitored closely and then annually. In the case of severe dysplasia, a check-up is necessary within 3 months and then treatment if necessary.
Today, the latter can be treated using minimally invasive endoscopic methods (mucosal resection, laser, heat destruction). Surgery to treat dysplasia is only necessary in exceptional cases.
Early carcinomas in a Barrett's esophagus can also be removed endoscopically. However, this should be reserved exclusively for specialized centers. These have a high number of cases and therefore the corresponding expertise.
In these cases, the endoscopist and surgeon should work together to determine the appropriate treatment.
The oesophagus is part of the digestive tract. The right person to contact if Barrett's oesophagus is suspected is therefore a gastroenterologist. Gastroenterology is a specialist area of internal medicine. A specialist in this field has therefore completed specialist training after studying medicine. This training lasts 6 years and includes both basic further training in internal medicine and three years of further training in gastroenterology.
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