The esophagus is a muscular tube that carries food from the mouth to the stomach. The stomach makes acid, which participates in the digestion of food. There is a valve between the esophagus and stomach that normally prevents acid and other stomach contents from being refluxed back into the esophagus. However, many people have a weak valve, and acid can reflux back onto the lining of the esophagus eventually resulting in Barrett's esophagus.
Under normal circumstances the esophagus is lined by a white tissue that is similar to the skin on the forearm, whereas the stomach is lined by a red, mucus-secreting tissue that is resistant to acid. When acid is refluxed onto the white lining of the esophagus, it can cause pain, which can be felt as heartburn or indigestion. If the acid reflux is not treated effectively, it can cause damage to the white lining of the esophagus.
After enough damage, the normal white esophageal lining can become replaced with a red lining that is called "Barrett's esophagus". This red lining secretes mucus and is therefore more resistant to acid than the normal white lining. However, the red lining of Barrett's esophagus is abnormal and differs from the normal red lining of the stomach.
The premalignant lining of Barrett's esophagus can be seen at endoscopy and diagnosed by endoscopic biopsy. It is therefore recommended that patients who have chronic heartburn or indigestion undergo endoscopy with biopsy to determine whether or not they have developed Barrett's esophagus.
In a minority of patients (approximately 5-10%), a subpopulation of cells within the red lining (Barrett's esophagus) can progress to become a cancer.
The changes in the cells lining the esophagus pose an increased risk for esophageal cancer. For unknown reasons, the incidence of cancers arising in Barrett's esophagus is increasing more rapidly than that of any other cancer in the United States. Unfortunately, most of these cancers are not detected until they have become so large that they are incurable. However, cancers in Barrett's esophagus that are detected when they are early and of small size, have a cure rate that is improved dramatically.
If Barrett's esophagus is diagnosed, regular follow-up endoscopic biopsy evaluations are recommended for the early detection of changes that could lead to cancer. Surgery is the only therapy that has been proven to cure early adenocarcinoma arising in Barrett's esophagus. Therefore, if an early cancer is detected in endoscopic biopsies, surgery is generally recommended to remove the cancer and the premalignant Barrett's epithelium.
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