The inner lining of the digestive tract is called the mucosa and is different in each organ.

When part of the esophageal mucosa is replaced by gastric mucosa and has a microscopic component that resembles that of the small intestine (intestinal metaplasia) it is called Barrett's esophagus.

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What causes it and why is it important?

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Generally, this mucosal change is caused by chronic burns caused by Gastroesophageal reflux and is important since it is a premalignant lesion, which causes cancer of the gastroesophageal junction.

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What are the symptoms?

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Barrett's esophagus does not produce any specific symptoms.

The symptoms reported by patients are inherent to gastroesophageal reflux, not Barrett's.

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Diagnosis

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Endoscopy is the method to diagnose Barrett's esophagus through suggestive macroscopic image and histological confirmation in biopsies taken in the endoscopic study.

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What is the association between Barrett's esophagus and esophageal cancer?

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Barrett's patients are 30 times more likely to develop esophageal cancer than the general population and therefore it is considered a premalignant lesion.

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How can Barrett's progress to cancer?

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It is not really known why a Barrett's esophagus (without dysplasia) begins to develop into low- and high-grade dysplasia and from there progresses to cancer. Theoretically, chronic irritation from stomach acid refluxing into the esophagus triggers this evolution.

Avoiding reflux with medical or surgical treatment (fundoplication) theoretically decreases the possibility of malignancy.

A very important aspect in patients with Barrett's esophagus is periodic endoscopic surveillance, since biopsies detect cellular changes that imply the imminent development of cancer, called severe dysplasia or carcinoma "in situ".

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If antireflux treatment or fundoplication do not remove Barrett's esophagus, how can it be eradicated?

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In general, only patients in whom Barrett's esophagus is discovered with severe dysplasia or carcinoma in situ is justified for eradication. Until recently, surgical removal of the esophagus (esophagectomy) was the only treatment.

Currently, there are less invasive endoscopic alternatives that promise to become a better treatment. It is important that the endoscopic treatment ensures, in a high percentage, the removal of the cancer in situ and that it destroys or removes all of the remaining Barrett's esophagus.

There are several endoscopic methods to destroy the Barrett but currently preference is given to mucosectomy and radiofrequency thermal destruction as they have proven to be very effective and have few complications.

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