My sister has a disease of the esophagus. Not sure of the name, something like “Briskitts”. I was told it can turn into cancer. What is this, and where can I get info on this disease?
I believe that today’s writer is referring to the condition known as “Barrett’s esophagus”, an abnormality of the lower part of the esophagus.
The esophagus is the long, muscular tube that connects the back of the throat to the stomach, and carries food and liquids that we swallow through the chest to the stomach for digestion. It is normally lined with a type of membrane known as squamous epithelium. Rhythmic contractions of the muscular esophagus actively propel food and water forward. This is not simply dependent on gravity, and in fact people can swallow food successfully and have it pass into their stomachs while standing on their heads.
Digestion in the stomach requires acid, and therefore our stomachs are normally very acidic. In a normal stomach this acidity does not cause pain or other symptoms, but if the acid is pushed back into the esophagus, a process called reflux, it does produce pain, which we commonly call heartburn.
The reflux of acid (and sometimes bile as well) into the esophagus may lead to inflammation of that structure if it occurs frequently or persistently. This inflammation is called esophagitis, and this is what is thought to lead to Barrett’s esophagus in some people. Under a microscope, a biopsy of the lining of the esophagus from an area of Barrett’s will show that the normal squamous cells have been replaced by abnormal cells resembling those found in the stomach.
Barrett’s esophagus may lead to ulcers in the esophagus, to strictures (constricted areas in the organ), and to bleeding. Nonetheless, about 25 percent of people with Barrett’s have no symptoms. The most serious complication is the development of cancer of the esophagus. It is estimated that the risk of esophageal cancer in someone with Barrett’s esophagus is 30-40 times that in the otherwise normal population. For this reason experts advise aggressive long-term treatment of the condition, with drugs to reduce acidity, and measures to prevent the reflux that allows the acidity to get up into the esophagus. Such measures include weight loss if one is heavy, eating small frequent meals rather than a few big ones, not lying down after eating, and not wearing clothing that constricts the abdomen.
It is usually recommended that people with Barrett’s have endoscopies to look at the area and perform biopsies every one to two years. If more dangerous changes are seen on the biopsy, the frequency of endoscopy should be increased. If esophageal cancer is found, then the esophagus must be removed surgically.
Unlike the more common type of esophageal cancer called squamous cell carcinoma, which is related to smoking and alcohol consumption, the type of cancer associated with Barrett’s seems to be related only to long-term reflux of stomach acid into the esophagus. Therefore heartburn is not a symptom to be treated lightly, and any persistent heartburn should be investigated by a doctor. Endoscopy may not be required in all cases if the symptoms are easily controlled by treatment, but should probably be done if symptoms persist despite effective treatment.
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