Barrett's esophagus refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal squamous epithelium of the esophagus by columnar epithelium with goblet cells, tissue similar to the intestinal lining. The medical significance of Barrett's esophagus is the fact that this mucosa is genetically unstable and its strong association (about 0.5% per patient-year) with esophageal adenocarcinoma, a very often deadly cancer, because of which it is considered to be a premalignant condition.
The main cause of Barrett's esophagus is thought to be an adaptation to chronic acid exposure from the stomach, and is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. The condition is found in 10–15% of patients who seek medical care for heartburn (gastroesophageal reflux disease), although a large subgroup of patients with Barrett's esophagus do not have symptoms.
Knowing what is the frequency of GERD in the general population is about 20 %, the prevalence of Barrett’s esophagus in Central and Eastern Europe is high. Although the risk for developing a malignant tumor is small (0.3 – 2%), it's important to have regular checkups for precancerous (metaplastic and dysplastic) cells. If precancerous cells are discovered, they can be treated to prevent esophageal cancer. The incidence of esophageal adenocarcinoma has increased substantially in the Western world in recent years.
In many countries there are recommendations to perform routine endoscopy of the upper digestive tract (sovereign method in detecting Barrett’s esophagus) in all adults aged 45 – 50 years. A number of these systematic endoscopies lead to the fact that the Barrett’s esophagus is often detected in patients who have no symptoms of GERD. This approach results in possible detection of malignant tumors of the esophagus at an early stage, when the disease is still curable.
Today there are several very efficient methods for endoscopic removal of Barrett’s esophagus. One of them, the endoscopic radiofrequency ablation (RFA) with Barrx™ system today represents a well-established, safe and effective procedure for the treatment of BE. Almost 15 years ago Barrx™ RFA revolutionized therapy for BE, with high eradication rates of metaplastic and dysplastic changes and excellent long term safety profile, on a huge number of patients. Barrx™ RFA today represents a “golden tool“ for selected patients with BE.
The story of Barrett’s esophagus is essentially a story about the awareness, early detection, prevention, contemporary surveillance, medicament, endoscopic and surgical treatment, and a very serious and highly professional approach to this increasingly present clinical problem.