When GERD Leads to Barrett’s Esophagus, New Treatment Can Help

For years, Jeff Bushey treated his persistent heartburn and indigestion with a combination of antacids and denial.

When he did see the doctor, his gastroenterologist diagnosed him with gastroesophageal reflux disease (GERD) and recommended that he change his diet, stop eating after 6 pm, lose weight, stop smoking and reduce his consumption of alcohol. “I never really followed the recommended lifestyle protocols,” Bushey admitted.

Under the care of his physician, Bushey, then 37, started taking acid-blocking medications. He also began having regular upper-endoscopy procedures to look at his digestive tract. Bushey’s physician monitored him for any changes in the lining of his esophagus, which is the swallowing tube that connects the mouth to the stomach. Over the next decade, Bushey’s condition progressed until he received a call. “After reviewing my most recent endoscopy, my doctor said my condition had gotten worse and he needed to refer me to someone who could treat my Barrett’s esophagus,” he said.

What is Barrett’s esophagus?

Barrett’s esophagus is a condition where the cellular lining of the lower portion of the esophagus changes. It's not clear exactly what causes Barrett's esophagus, but chronic acid reflex (GERD) can increase the risk. When stomach acid irritates the lining of the esophagus over a period of time, a type of inflammation called esophagitis may occur. The condition may also cause the esophagus to develop a more acid-resistant cellular lining.

With Barrett’s esophagus, there is a small increased risk that the lining may begin to exhibit pre-cancerous cell growth called displasia, according to Harry Aslanian, MD, a gastroenterologist at Smilow Cancer Hospital and professor of Medicine at Yale School of Medicine. By the time Bushey arrived in Dr. Aslanian’s office, his condition had progressed to advanced dysplasia and areas within the esophagus’ inner lining showed signs of early cancer.

Risk factors and symptoms

Dr. Aslanian said not every patient with GERD will develop Barrett’s esophagus, and most Barrett’s esophagus cases do not advance to a pre-cancerous stage. However, it’s important to monitor and treat if dysplasia does develop. A study published by the American Gastroenterological Association found that between 2012 and 2019 rates of Barrett’s esophagus grew by 50 percent in adults ages 45 to 64 – and rates of esophageal cancer doubled. Like most cancers, it’s much easier to treat esophageal cancer in earlier stages.

Risk factors include:

• a family history of Barrett's esophagus or esophageal cancer
• chronic GERD
• being overweight
• alcohol consumption 
• smoking
• being over the age of 50

“If you have any of the risk factors, particularly long-term acid reflux symptoms and/or a family history of esophageal cancer, make sure to tell your doctor. Endoscopy may be considered to screen for Barrett’s esophagus,” Dr. Aslanian said. 

If you have any of the following symptoms, call your doctor:

• Persistent, bad heartburn
• Food or water that won’t move down your throat
• Difficult or painful swallowing
• A feeling that something’s wrong when swallowing

Treatment for Barrett’s esophagus

Traditional treatment for Bushey’s condition in the past would have included a surgical procedure called an esophagectomy, which is when the lower portion of the esophagus is removed and then reconstructed using tissue from the stomach, said Dr. Aslanian. Bushey wanted to avoid the procedure, if possible, because recovery can be complex and lengthy.

Within the past few years, however, new endoscopic resection and radiofrequency ablation (RFA) techniques have been developed to treat advanced dysplasia in patients with Barrett’s esophagus. Detailed imaging precisely pinpoints the pre-cancerous areas within the esophagus. These tissues are cut out through an endoscope and the remaining areas are treated with RFA, which applies calibrated heat energy to destroy flat/lower risk areas of Barrett’s esophagus. These endoscopic procedures are minimally invasive for patients, meaning less pain and a faster recovery than conventional surgery.

“Endoscopic treatments are performed as outpatient procedures and are low risk, with recovery typically requiring only taking a liquid and soft diet for a few days,” Dr. Aslanian said. After treatment, the condition can be completely eradicated in approximately 85 percent of patients. Follow-up includes endoscopy to monitor if any recurrent Barrett’s requires additional endoscopic therapy in the future, Dr. Aslanian said.

Advice for those living with GERD

Six months after his procedure, Bushey, now 55, is feeling good. “The Barrett’s tissue is removed, healthy tissue has grown back, and I don’t have heartburn anymore,” he said.

His advice to others who are struggling with GERD? Listen to your symptoms – and your doctors.

“It’s hard to accept the facts when you are faced with a diagnosis you don’t want to hear, but it’s better to take care of your health when you still have it,” he said. “Everything I should have done in my younger days, I’m doing now.”