The gastroenterology program at Loyola Medicine treats Barrett's esophagus, a condition that can be a precursor to an increasingly common type of esophageal cancer. Loyola's gastroenterology specialists have been involved in research on the causes of and treatments for this condition; their research has resulted in a range of treatment options.
For people with Barrett's esophagus, the normal membrane that covers the esophagus from the inside (squamous mucosa) is replaced by different type of membrane, called a columnar epithelium. This likely happens as a result of chronic gastroesophageal reflux. This is a concern because it is related to an increased risk for developing cancer in this type of membrane.
Your Loyola gastroenterologist may recommend that you have an endoscopy to positively diagnose Barrett's esophagus. A thin, flexible tube will be inserted into your esophagus, allowing your doctor to view the tissue of your esophagus. A biopsy, where tissue samples are taken of your esophagus and sent to a lab for tests, also may be done.
If you are diagnosed with Barrett's esophagus, your doctor may recommend lifestyle changes, medication or surgery, depending on the stage and severity of your condition.
Lifestyle changes are intended to control the gastroesophageal reflux disease (GERD) that can lead to Barrett's esophagus. These changes are meant to keep your condition from getting any worse. Recommendations may include that you:
- Avoid foods and activities that often trigger GERD
- Eat small meals more often
- Elevate the head of the bed
- Lose weight
- Monitor your caffeine and fat intake
- Sit straight up during and after eating
- Stop smoking
Your Loyola doctor may prescribe medications to help you reduce stomach acid. This may be done in conjunction with lifestyle changes or as a secondary treatment. You also may be prescribed medication to heal any sores in your esophagus.
Medication to reduce stomach acid is a common treatment if you have Barrett's esophagus. Medications do not cure the disease, but help keep it in check. Barrett's esophagus with high grade dysplasia is considered highly precancerous and requires additional treatment beyond medication.
If your Barrett's esophagus is severe or is not controlled by medication, your doctor may recommend surgery. Your surgeon will review your case and make an individualized recommendation for the most appropriate procedure. Procedures performed by Loyola’s expert surgeons to treat Barrett's esophagus include:
- Cryotherapy — A new method that uses liquid nitrogen to freeze the affected area of the esophagus. The diseased tissue eventually sloughs off, and the area covers over with normal epithelium as long as you keep stomach acid suppressed. Loyola is the first in Illinois to use cryotherapy treatment for Barrett's esophagus.
- Endoscopic mucosal resection (EMR) — A procedure that involves removing the diseased part of your esophagus through an endoscope. The procedure, which spares the removal of your esophagus, can be done on an outpatient basis. In most cases, you may return to your normal activities the next day.
- Esophagectomy — A major surgery in which part of the esophagus is removed. The remaining part may be connected directly to the stomach so that you can swallow. This is a significant surgery that will cause permanent lifestyle changes. It is reserved for patients with invasive esophageal cancer and some patients with severe reflux disease.
- Radiofrequency ablation — Involves placing an electrode directly on the diseased tissue in the esophagus. The electrode destroys the disease using heat. Several sessions of ablation may be needed before Barrett's esophagus is completely gone. This is an outpatient procedure. Some patients experience minor chest pain during the first week following the procedure, but this is managed with prescription medication.
Your Loyola gastroenterologist will discuss all options with you, including the risks and benefits of any recommended treatment plan. Surgery may be recommended if endoscopic treatments are not possible, not recommended or may be ineffective for your particular situation. Loyola’s doctors are expert in the treatment of Barrett’s esophagus and will provide the most advanced care with precision and compassion.