While no relationship exists between the severity of heartburn and the development of Barretts esophagus, a relationship does exist between chronic heartburn and the development of Barretts esophagus. Sometimes, people with Barretts esophagus have no heartburn symptoms at all. Some anecdotal evidence indicates those with the eating disorder bulimia are more likely to develop Barretts esophagus because bulimia can cause severe acid reflux, and because purging also floods the esophagus with acid. However, a link between bulimia and Barretts esophagus remains unproven.During episodes of reflux, bile acids enter the esophagus, and this may be an important factor in carcinogenesis. Individuals with GERD and BE are exposed to high concentrations of deoxycholic acid that has cytotoxic effects and can cause DNA damage. Diagnosis
Both macroscopic (from endoscopy) and microscopic positive findings are required to make a diagnosis. Barretts esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia. The secretory columnar epithelium may be more able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased risk of adenocarcinoma. Screening
Screening endoscopy is recommended among males over the age of 60 who have reflux symptoms that are of long duration and not controllable with treatment. Among those not expected to live more than 5 years screening is not recommended.The Seattle protocol is used commonly in endoscopy to obtain endoscopic biopsies for screening, taken every 1 to 2 cm from the gastroesophageal junction.
A recent five-year random-controlled trial has shown that photodynamic therapy using photofrin is statistically more effective in eliminating dysplastic growth areas than sole use of a proton pump inhibitor.There is presently no reliable way to determine which patients with Barretts esophagus will go on to develop esophageal cancer, although a recent study found the detection of three different genetic abnormalities was associated with as much as a 79% chance of developing cancer in six years.Endoscopic mucosal resection has also been evaluated as a management technique. Additionally an operation known as a Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus.In a variety of studies, nonsteroidal anti-inflammatory drugs (NSAIDS) such as low-dose aspirin (75-300 mg/day) have shown evidence of preventing esophageal cancer in people with Barretts esophagus. Prognosis
Barretts esophagus is a premalignant condition, not a malignant one. Its malignant sequela, esophagogastric junctional adenocarcinoma, has a mortality rate of over 85%. The risk of developing esophageal adenocarcinoma in people who have Barretts esophagus has been estimated to be 6–7 per 1000 person-years, but a cohort study of 11,028 patients from Denmark published in 2011 showed an incidence of only 1.2 per 1000 person-years (5.1 per 1000 person-years in patients with dysplasia, 1.0 per 1000 person-years in patients without dysplasia).The relative risk of esophageal adenocarcinoma is about ten times higher in those with Barretts esophagus than the general population. Most patients with esophageal carcinoma survive less than one year.