Barrett’s Esophagus

Barrett’s esophagus, also known as Barrett’s Disease, is a disorder in which constant exposure to stomach acid causes injury to the cells of the lower esophagus. Left untreated, Barrett’s esophagus raises a patient’s risk of developing esophageal cancer by up to 80% . Patients with Gastroesophageal Reflux Disease (GERD), are more likely to develop Barrett’s esophagus than those in the general population.

Also known as acid reflux, GERD is a fairly common digestive disorder that occurs when stomach acid and sometimes bile, refluxes or flows back into the esophagus and mouth.

Symptoms of Barrett’s Esophagus

  • Difficulty swallowing food
  • Chest pain
  • Pain in the upper abdomen

In patients with Barrett’s esophagus, the altered cells in the esophagus can become abnormal. This condition is called dysplasia. Cells with high-grade dysplasia are more likely to become cancerous. The following risk factors may increase a patient’s chance of developingdDysplastic Barrett’s esophagus:

  • Continued exposure from acid reflux
  • Long segment Barrett’s
  • Family history of Barrett’s

Testing for Barrett’s Esophagus

Dr. Singh, Dr. Rashbaum, Dr. Nitin ParikhDr. Long B. Nguyen, and providers Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN; perform a variety of procedures to diagnose Barrett’s esophagus. The tissue in a healthy esophagus appears pale and glossy; if Barrett’s Esophagus is present, tissue will look red and may resemble the intestinal lining. Depending on the severity of the condition, a biopsy of the tissue in the esophagus may be taken to test for abnormalities. The most common procedures performed to diagnose Barrett’s esophagus:

Treatment Options

Over-The-Counter Medication: Most often, GERD can be managed with lifestyle changes and over the counter medications. However, it is important to know that these treatments only offer temporary relief and do not provide any healing elements.

  • Antacids: After diet changes, antacids are usually the first course of action because they provide quick relief of symptoms. These include products such as Maalox, Mylanta, Rolaids, and Tums.
  • H2 Receptor Blockers: These do not act as quickly as antacids but they do provide longer relief. Popular H2 receptor blockers include Pepcid AC and Zantac.
  • Proton Pump Inhibitors: These drugs are designed to prevent acid production and release in the stomach and intestines, thereby reducing the risk of acid reflux and esophageal damage. Common examples are Prevacid 24 and Prilosec OTC.

Prescription Medication: Sometimes, over-the-counter treatments are not strong enough to provide relief in more severe cases, so Dr. Singh and Dr. Rashbaum may recommend GERD prescription medications to ease Barrett’s Esophagus symptoms and progression.

  • Prescription Strength H2 Receptor Blockers: These include drugs such as Tagamet, Pepcid, Axid, and Zantac.
  • Prescription Strength Proton Pump Inhibitors: Common examples are Nexium, Prevacid, Prilosec, Protonix, Aciphex, and Dexilant. When taking proton pump inhibitors at the prescription level, your doctor may recommend a calcium supplement because these medications can cause a loss of bone mass.
  • Prokinetic Agents: These treatments are used to strengthen the lower Esophageal Sphincter and are also given to patients with slow gastric emptying since they speed up digestion so acid does not stay in the stomach for any longer than necessary. These drugs can cause significant side effects such as fatigue, depression, and anxiety and may also interfere with the effectiveness of other medications.

Periodic Surveillance Endoscopy: In cases of diagnosed Barrett’s Esophagus, a healthy GERD diet is not enough and surgery is sometimes necessary. Most doctors will not perform surgery until all other options have been exhausted and it has become obvious that lifestyle changes in terms of, among other things a GERD diet and medications are not effective.

Endoscopic Ablative Therapy: Endoscopic Ablative Therapies use different techniques to destroy the Dysplasia in your Esophagus. After therapy, your body should begin making normal Esophageal cells. The most common procedures are the following:

  • Hotodynamic Therapy: Photodynamic Therapy uses a light-activated chemical called porfimer (Photofrin), an Endoscope, and a laser to kill precancerous cells in your Esophagus. Dr. Ranvir Singh, Dr. Stephen Rashbaum, or Dr. Nitin Parikh will inject porfimer into a vein in your arm, and you return 24 to 72 hours later to complete the procedure.
  • Radiofrequency Ablation: Radiofrequency Ablation uses radio waves to kill precancerous and cancerous cells in Barrett’s tissue. An electrode mounted on a balloon or an Endoscope creates heat to destroy the Barrett’s tissue and precancerous and cancerous cells.

Endoscopic Mucosal Resection: In Endoscopic Mucosal Resection, Dr. Ranvir Singh, Dr. Stephen Rashbaum, or Dr. Nitin Parikh lifts the Barrett’s tissue, injects a solution underneath or applies suction to the tissue, and then cuts the tissue off. The doctor then removes the tissue with an Endoscope. Before performing an Endoscopic Mucosal Resection for cancer, your doctor will do an Endoscopic Ultrasound.

Surgery: Surgery called Esophagectomy is an alternative to Endoscopic therapies. Esophagectomy is the surgical removal of the affected sections of your Esophagus. After removing sections of your Esophagus, Dr. Singh, Dr. Rashbaum, Dr. Nitin Parikh, Dr. Long B. Nguyen, Dr. Ruth Moontalvo, and providers Tammi D’Elena, PA-C; and Vanessa T. Dang, MSN, APRN rebuild your Esophagus from part of your stomach or large intestine. The surgery is performed at a hospital. You’ll receive general anesthesia, and you’ll stay in the hospital for 7 to 14 days after the surgery to recover. Surgery may not be an option if you have other medical problems. Your doctor may consider the less-invasive endoscopic treatments or continued frequent surveillance instead.

Dietary Guidelines

The following list is comprised of foods that are typically known to be ‘safe’ or to ‘trigger’ symptoms.

Food GroupsFood to AvoidFoods to Add to Your Diet
FRUITSOranges and orange juice, lemons and lemonade, grapefruit and grapefruit juice, tomato and tomato juice, cranberries and cranberry juiceApples (fresh and dried), apple juice, bananas, pears, peaches, melons, strawberries, grapes
VEGETABLESRaw onions, peppers, radishes, french fries, mashed potatoesBaked potato, broccoli, cabbage, carrots, green beans, peas, asparagus, lettuce, sweet potatoes
MEATFatty ground beef, marbled sirloin, chicken nuggets, buffalo wings, fried meatExtra lean ground beef, steak (London Broil), skinless chicken breast, egg whites or substitute, fish (with no added fat), white turkey meat
DAIRYWhole milk, chocolate milk, ice cream, high fat cream cheese or sour creamFeta or goat cheese, fat-free cream cheese, fat-free sour cream, low-fat soy cheese
GRAINSHigh-fat grain products (cheese bread or products made with whole milk)Cereal (bran or oatmeal), cornbread, graham crackers, pretzels, rice (brown or white), rice cakes, millet, quinoa
BEVERAGESCaffeinated beverages, whole milk, alcohol, carbonated beveragesWater, herbal teas, non-citrus drinks, skimmed milk
FATS/OILS/CONDIMENTSStrong mustard, chili sauces, creamy salad dressing, black pepper, vinegar, curries, pickles, mintLow-fat salad dressing, herbs ( basil, thyme, sage, oregano), hummus, mild sauces

Board-Certified physicians Dr. Ranvir SinghDr. Stephen RashbaumDr. Nitin J. ParikhDr. Long B. Nguyen, Dr. Ruth Montalvo, Dr. Jae Kim, and providers Tammi D’Elena, PA-C and Vanessa T. Bridgeman, MSN, APRN, FNP-BC; care for patients in the North Atlanta, GA; area including Johns Creek, GA, Cumming, GA, Lawrenceville, GA,  Alpharetta, GA, and Dawsonville, GA. The in-house endoscopy suite at Digestive Care Physicians is a certified facility which has achieved the highest level of accreditation by the Association for Ambulatory Health Care (AAAHC). If you suffer from gastrointestinal problems, abdominal pain, or need a colorectal cancer screening, contact us at (770) 227-2222 to schedule an appointment.

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Dr. Ranvir Singh, Dr. Stephen Rashbaum, Dr. Long Nguyen, Dr. Nitin Parikh, Dr. Ruth Montalvo, Dr. Jae Kim, Tammi D’Elena, PA-C, and Vanessa Bridgeman, MSN, FNP-BC

For clinical questions, please contact our office: 770-227-2222

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