Should You Be Concerned About Barrett's Esophagus?

Barrett’s Esophagus is a condition where the lining of the esophagus is damaged by stomach acid and is replaced by tissue similar to that which is found in the stomach. The exact cause of Barrett’s Esophagus is unknown, but it is commonly seen in people with gastroesophageal reflux disease, or GERD. Reflux occurs when the contents of the stomach rises into the esophagus, which may cause heartburn or indigestion. Occasional reflux is common, but for those who experience this sensation more than twice a week, a diagnosis of GERD is made. Within this population, Barrett’s Esophagus affects about 1% of Americans, or about 700,000 adults (1), and it may progress into esophageal adenocarcinoma, a deadly form of cancer of the esophagus. Barrett’s Esophagus does not cause any signs or symptoms, so it is important for individuals suffering from chronic reflux (GERD) to visit their doctor for an endoscopy and biopsy of the esophageal tissue regularly. Although cancer diagnosis is rare, most diagnoses are made late stage when treatment is ineffective. Early detection of precancerous cells (dysplasia) may prevent the development of esophageal cancer (2).

Risk Factors

Individuals with the following characteristics are at higher risk for developing Barrett’s Esophagus:

• Diagnosed with GERD, or experiencing constant reflux

• Heavy alcohol and tobacco use

• Older age

• Being male

• Being Caucasian

• Obesity

• Consuming a poor diet (3, 4).

Research

A study published in the American Journal of Gastroenterology found that diets high in antioxidants such as Vitamin C, E, and beta-carotene are related with a reduced risk for Barrett’s Esophagus. Consuming a diet high in fruits and vegetables, versus the typical Western Diet of processed foods, showed the greatest reduction in risk. It is important to note that similar results were not found in individuals who took supplements. It is theorized that there are other compounds in whole fruits and vegetables with beneficial, anti-cancer properties. Parallel findings were also discovered in a study completed by the National Institute of Health; Individuals consuming low amounts of raw fruits and vegetables were associated with a greater risk of developing cancer associated with Barrett’s Esophagus (5, 6).

Prevention and Recommendations

An effort to minimize acid reflux may reduce the risk of progression to Barrett’s Esophagus. The following is a list of various lifestyle changes that can be made to decrease this likelihood:


Smoking Cessation

• Smoking is strongly associated with cancer of the esophagus and can contribute to the esophageal cancer related to Barrett’s Esophagus.


Drink in Moderation

• Alcohol relaxes the mechanism that prevents stomach contents from entering the esophagus.


Sleeping Habits

• Avoid lying down three hours following meals.

• Sleep with your head elevated to prevent acid from rising into the esophagus.


Weight Loss

• Loosing weight improves GERD symptoms, as well as reduces the risk for both Barrett’s Esophagus and the development of cancer.


Dietary Changes

• Eat a low-fat diet, as high fat meals take longer to digest thereby increasing the risk for acid to rise.

• Consume small, frequent meals.

• Increase daily intake of raw fruits and vegetables, especially those high in antioxidants.

• Reduce caffeine intake to 2 – 3 cups per day. Caffeine, similar to alcohol, relaxes the mechanism in the esophagus that prevents acid to rise.

• Foods such as chocolate, spicy foods, and peppermint have also been show to aggravate reflux and should be avoided as necessary (1, 7, 8).



Resources:
1. Dunbar, K. (2009, April 21). Barrett's Esophagus. Retrieved March 30, 2012, from John Hopkin's Pathology: http://apps.pathology.jhu.edu/blogs/barretts/?p=48

2. Locke, G., & Rich, J. (2008, July 1). Barrett's Esophagus. Retrieved March 30, 2012, from National Institute of Digestive Diseases Information Clearlinghouse: http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/

3. National Cancer Institute. (2011, December 23). Esophageal Cancer Treatment. Retrieved March 30, 2013, from National Cancer Institute at the National Institute of Health: http://www.cancer.gov/cancertopics/pdq/treatment/esophageal/Patient

4. The Cleveland Clinic Foundation. (2009). Barrett's Esophagus. Retrieved March 30, 2012, from Cleveland Clinic: http://my.clevelandclinic.org/disorders/barretts_esophagus/hic_barrett%27s_esophagus.aspx

5. Tufts University. (2008). Antioxidants from Produce May Protect Esophagus. Tufts University. Boston, MA: Tufts University Health and Nutrition Newsletter.

6. Brown, L., Swanson, C., Gridley, G., Swanson, G., Shoenberg, J., Greenberg, R., et al. (1994). Adenocarcinoma of the Esophagus: Role of Obesity and Diet. Journal of the National Cancer Institute , 87 (2), 104-109.

7. Clark, G., Smyrk, T., Mirvish, S., Anselmino, M., Yamashita, Y., Hinder, R., et al. (1993). Effect of Gastroduodenal Juice and Dietary Fat on the Development of Barrett's Esophagus and Esophageal Neoplasia. 1 (3), 252-261.

8. Academy of Nutrition and Dietetics. (2012). Nutrition Therapy for Gastroesophageal Reflux Disease. Nutrition Care Manual . Chicago, IL.

About the Author

Stephanie Wilson is a senior nutrition major at Rochester Institute of Technology.  This May she will graduate from RIT and begin her Dietetic Internship at California Polytechnic in San Luis Obsipo.  Stephanie proudly describes herself as a marathoner, foodie, musician, and blogger at OntheRoadtoRD.com.  She hopes to one day follow in Carol’s footsteps and become a private practice dietitian and share her love of both nutrition and exercise with the public!