Heartburn and Barrett's esophagus
If you stop and think about it, it's amazing that your stomach does not digest itself. The powerful hydrochloric acid inside your stomach is strong enough to liquify a piece of meat that you swallow. Your stomach is also made out of meat, or muscle tissue. Why doesn't it digest itself? Actually, the stomach is protected from its own acid by a special mucous layer that covers the inner lining. Unfortunately, the esophagus didn't get such a "raincoat." Instead, there is a one-way "valve" called the Lower Esophageal Sphincter. This is like a tiny trapdoor between your foodpipe and stomach. It lets the food go down into the stomach pouch, but then closes to prevent the backsplash of acid onto the delicate esophageal lining.
When the valve malfunctions, acid splashes (refluxes) upward and begins to damage the lower part of the esophagus. With repeated exposure, ulcers may form. This is called Gastroesophageal Reflux Disease, or GERD.
The tissue that lines the esophagus is different than that covering the stomach. When the esophagus ulcers heal, you would expect the normal esophagus tissue to patch the spot. Sometimes, for reasons unknown, the stomach lining creeps upward into the lower esophagus and covers the spot. Now you have stomach lining inside the lower esophagus. This condition, called Barrett's esophagus, is permanent even after the ulcers heal. It is not really a problem, except that the risk of cancer of the esophagus is higher is patients with Barrett's esophagus - 30 to 60 times greater than the general population.
While esophagus cancer can sometimes develop directly, Barrett's esophagus usually develops into cancer via a five-step process that permits time for early diagnosis and intervention. Over time, patients go through these stages:
- esophagitis (GERD)
- Barrett's esophagus
- low-grade dysplasia (pre-cancer)
- high-grade dysplasia (almost cancer)
- carcinoma-in-situ Stage 0 ( a few early confined cancer cells)
- adenocarcinoma (cancer Stages I to IV)
Patients with GERD and those who have gone on to develop Barrett's changes need aggressive therapy and close monitoring to reduce their risk of cancer. The best approach is to prevent Barrett's in the first place by treating chronic heartburn avoiding all tobacco, and only drinking in moderation.
Not everybody who experience heartburn needs to see their doctor. But if the symptoms are frequent, severe, or progressive, seek medical attention. While new and improved over-the-counter drugs like Pepcid AC and Tagamet HB have helped some heartburn sufferers find relief, many experts fear that the medications may be masking symptoms of more serious problems. While the drugs can be helpful for people with occasional heartburn and indigestion, a person should seek a doctor's help if symptoms last two weeks or more, experts say. If you have heartburn, ask yourself these questions:
- Do you take antacids two or more times a week?
- Do you take heartburn medicine(s) other than antacids?
- Does your heartburn interfere with your daily activities?
- Do these symptoms often occur after meals?
- Do these symptoms interfere with your sleep?
- Do you find that your medicine only relieves your symptoms for short periods of time?
- Do you have difficulty swallowing?
Heartburn and Barrett's esophagus
