GERD Complications: Barrett's Esophagus and Esophageal Cancer

Barrett's esophagus occurs when the normal cells that line the lower esophagus are replaced by a different cell type called intestinal cells. This process usually results from repeated damage to the esophageal lining by the acid in your stomach backing up into the esophagus. 

The intestinal cells have a risk of transforming into cancer cells over time. 

If you have had acid reflux for a long time, it's important to know if you also have Barrett's esophagus. That's because Barrett's esophagus can later turn into pre-cancer or cancer of the esophagus.

Dr. Arevalo can do a test called an upper endoscopy to check for Barrett's esophagus.

What are the two main types of esophageal cancer?

• Adenocarcinoma: It develops out in glandular cells, which are not normally present in the lining of the esophagus. These cells can grow there due to Barrett’s Esophagus. Adenocarcinoma occurs mainly at the lower end of the esophagus and the upper part of the stomach.
• Squamous Cell Carcinoma: This type of cancer develops from the thin, flat cells (called squamous) that begin to grow uncontrollably. Squamous Cell Carcinoma is often related to smoking and drinking excessively. 

Symptoms may not appear in the early stages of esophageal cancer. In more advanced cancers, symptoms can include:

• Vomiting after eating
• Trouble swallowing
• Weight loss
• Chest pain
• Coughing and spitting up
• Vomiting blood
• Indigestion and prolonged heartburn

What are the risk factors?

Esophageal cancer usually cannot be found until it is in an advanced stage. So early endoscopy surveillance is very important.

• Adults over 50 years of age
• Chronic GERD
• Having bile reflux
• Barrett's Esophagus 
• Smoking
• Drinking alcohol
• Being obese

Is there a test for esophageal cancer?

Yes. Dr. Arevalo can do a test called an upper endoscopy to check for Barrett's esophagus and cancer.

During an upper endoscopy, a thin tube with a camera is introduced into your mouth to see your esophagus. Dr. Arevalo will look at the lining of the esophagus and take a small sample of it. Another doctor will look at the cells under a microscope to see if you have Barrett's esophagus. 

What are the treatment options?

The choice of treatment will depend on the patient's overall health and the stage of cancer. It may include chemoradiotherapy with or without esophagectomy. And in highly selected cases, it may include an endoscopic resection.

Relief of symptoms: Other measures are intended only to relieve symptoms, especially difficulty swallowing. One example is stretching to open the constricted area of ​​the esophagus and then inserting a flexible metal mesh tube (stent) to hold the esophagus open. Proper nutrition makes any type of treatment more viable and better tolerated. If the patient can swallow, he can take concentrated liquid nutritional supplements. In other cases, people who cannot swallow may require feeding through a tube placed in the stomach through the wall of the abdomen (gastrostomy tube).

Prevention

As it is logical to think, prevention involves avoiding the risk factors associated with the development of esophageal cancer:

• Aggressive endoscopic surveillance

• Treat the chronic GERD root cause
• Avoid development of Barrett's esophagus 
• Quit smoking
• Drink alcohol with moderation