Barrett’s esophagus: a consequence of heartburn

If you frequently suffer from heartburn, the esophagus will become damaged because it cannot withstand the acidic gastric juice. Over time, the esophagus will become inflamed and can be irreparably damaged. In Barrett’s esophagus, part of the esophagus is lined with tissue that resembles the lining of the stomach and small intestine. This can occur after sometimes years of exposure to stomach acid. What does this condition mean and how can it be treated?

Heartburn

When the stomach acid returns to the esophagus, it gives an unpleasant feeling. The esophagus cannot withstand these acidic stomach contents. It causes complaints such as a burning or pressing feeling behind the breastbone. It can cause pain and radiate to the neck and between the shoulder blades. The return of stomach contents is also called reflux. Some people suffer from belching, where small amounts of stomach contents keep coming up and it can even come back into the mouth. It can also feel like a lump in the throat. The complaints can worsen when someone lies down or when a woman is pregnant.

How it arises

Normally, the sphincter between the esophagus and stomach should close again when food has passed. If this no longer works properly or remains open for too long, the stomach contents can flow back into the esophagus. The esophagus cannot withstand this acidic stomach contents and this causes unpleasant complaints. Over time, esophagitis can develop, causing permanent changes in the tissue in the esophagus. This is also called Barrett’s esophagus.

What Barrett’s esophagus entails

A normal esophagus is a tube about 30 centimeters long that begins after you swallow food and runs down to the stomach. It is lined on the inside with a mucous membrane layer. In Barrett’s esophagus, the tissue of the esophagus has changed due to chronic damage to the stomach acid. The wall of the esophagus is partially covered with a different type of tissue than in a healthy esophagus. People with this condition are more likely to develop esophageal cancer. It mainly occurs in white men over 50 years of age. About 5% of adult Dutch people have Barrett’s esophagus.

Complaints

In addition to the burning sensation, other complaints may also arise. For example, the patient may experience difficulty swallowing or passage complaints may arise. This means that the food does not sink down properly after swallowing. The complaints can vary per person. There are also people with Barrett’s esophagus who have no complaints.

The change of the mucous membrane

If esophagitis continues, the tissue of the esophagus may permanently change. The newly formed mucosa in the esophagus is called Barrett’s mucosa. Most people who frequently suffer from heartburn will not develop Barrett’s esophagus. It is not yet known why it occurs in some people and not in others. There are varying degrees of Barrett’s esophagus based on the severity of the tissue change. Depending on the form of the condition, the doctor will propose treatment and regular check-ups.

Diagnosis

The diagnosis can be established by endoscopy. A flexible tube containing a camera is inserted into the esophagus and a visual examination is performed. This allows the doctor to see whether there is esophagitis and whether there has been a change in the tissue. If the doctor wants to take a piece of tissue, he will do this via a biopsy and examine it under a microscope. The diagnosis can only be definitively made after microscopic examination.

Therapy

The treatment that will take place depends on the nature of the complaints. Not all treatments are suitable for every patient. Some patients are prescribed antacids. Certain antacids are available over the counter, but long-term use is not recommended. This will not cure Barrett’s esophagus, but it can help prevent the spread of tissue change. In some cases, a pre-cancerous stage may develop. If this is the case, the abnormal tissue is removed via an endoscopic procedure. If the tissue change is already more advanced, this treatment is not possible. As follow-up treatment, antacids will still have to be used. In some cases, the affected mucous membrane is removed by means of radiotherapy. If the cancer is in an advanced stage, the entire esophagus is removed. This is a major operation.

Prevention

If you regularly suffer from heartburn, it is wise to do something about it. To prevent a damaged esophagus, with all the unpleasant consequences that can arise from it, you can take the following into account:

  • Avoid large and fatty meals
  • Eat several smaller portions throughout the day
  • Don’t eat right before you go to sleep
  • Do not lie down if you have just eaten, as the stomach contents can easily flow back
  • Make sure your head end is higher than the foot end of your bed
  • Avoid bending over
  • Being overweight can increase pressure on the stomach
  • Eat healthy, a blockage can increase pressure on the stomach
  • Avoid tight clothing that presses on the stomach
  • Smoking can relax the sphincter between the stomach and esophagus

You can also make sure that you limit the following foods as much as possible: coffee, alcohol, chocolate, peppermint, citrus fruits and sharp herbs. The foods that cause reflux can differ per person. For example, one person can tolerate cucumber just fine, while another gets enormous belches from it.

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