GERD: What is Barrett’s Esophagus?

Barrett’s Esophagus is a condition where the lining of the esophagus has been repeatedly damaged by exposure to stomach acid and the body repairs the damage using a different type of tissue.  So instead of replacing the damaged cells with cells that would be found in the esophagus the cells are replaced with cells similar to those found in the intestine and because of this the process is known as intestinal metaplasia.

Barrett’s Esophagus does not give the sufferer any symptoms so it can only be diagnosed by visual examination using an endoscope.

The cells that line the esophagus and those that line the stomach are different types of cells which have different functions and there is a defined line which marks the border between the two.  This defined line and the fact that the two types of cells also look very different make it easy for the physician to see the abnormal cells which have developed and to diagnose Barrett’s Esophagus.

There is no treatment to reverse this condition so the best possible treatment strategy is to prevent it occurring in the first place and this is why preventing acid reflux is so important.  If you have never heard of Barrett’s Esophagus you might wonder why you would need to prevent a condition that causes no symptoms.  The reason is that in a small percentage of cases the condition can progress to esophageal cancer.

As you cannot reverse the condition surgery or other alternative procedures will be recommended if a biopsy shows severe or high-grade dysplasia in the cells.  Surgery can be used to remove the abnormal lining or laser or high energy treatment can be used to destroy the precancerous cells in situ.

Does Heartburn Have Anything to Do With the Heart?

The short answer to that question is no.

The term heartburn originates from the burning sensation which can be felt in the middle of the chest close to the heart.  It is pain caused by the damage to the esophagus that the reflux of acid from the stomach causes and it has nothing to do with the heart at all. However, having said that heartburn has nothing to do with the heart, the symptoms of heartburn can be very similar to the signs of heart disease. If you experience heartburn with any of the symptoms listed below you should consult your doctor immediately as it may possibly mean that you’re having a heart attack.

  • Pain radiating into your back, neck, jaw, shoulders or arms — especially your left arm
  • Sudden pressure, tightening, squeezing or crushing pain in the center of the chest that doesn’t disappear after a few minutes
  • Feeling light-headed or dizzy
  • Being short of breath or having difficulty breathing
  • Becoming clammy or sweaty
  • Vomiting with blood
  • Bloody or black stools

You should also contact your doctor immediately if your heartburn feels different or more severe than normal and it occurs during or immediately following physical activity or, if you experience any new chest pain or discomfort and you smoke, are overweight or have heart disease diabetes, high cholesterol or previously had a heart attack.  Remember that correct diagnosis and prompt medical treatment can save lives.  Although the occasional occurrence of heartburn is extremely common and should be of little concern, if you are regularly experiencing heartburn you need to speak with your doctor as this could mean you have an ulcer or other underlying health condition. Heartburn caused by acid reflux usually increases after eating but if your heartburn is worse before eating, it can be a sign that you have an ulcer.

Why Does Heartburn Return When I Stop Taking Medication?

One possible reason for your heartburn returning is that your medication may be masking the problem. Traditional heartburn medication works by suppressing the acid levels in your stomach but you have to remember that your stomach is meant to be a highly acidic place. The acid in your stomach is there to breakdown food and protect you by killing off bacteria and parasites. By reducing the acid levels in your stomach the medication reduces the damage to the esophaghus when the acid reflux occurs but it doesn’t tackle the underlying reason for the reflux. This means that when you stop taking the medication your acid levels return to their previous levels and the heartburn returns.

Apart from physical causes of heartburn such as pregnancy or obesity placing pressure on the stomach, the most widespread theory for the cause of heartburn puts the blame squarely with the production of excess stomach acid. There is however another school of thought which believes that heartburn is caused by insufficient acid in the stomach. This theory believes that where there is insufficient hydrochloric acid the stomach is no longer able to deal with bacteria and parasites, or foods that are not easily tolerated, such as wheat or dairy products, and the lining of the stomach becomes inflamed. It is this inflammation which is made worse by contact with stomach acid causing the symptoms of heartburn.

The acid levels in the stomach work to both close the lower esophageal sphincter (LES) to protect the delicate tissues of the esophaghus and to trigger opening of the pyloric valve, between the stomach and the small intestine. If the pyloric valve is not opened to release the stomach contents the undigested food will become rancid and start to ferment causing gas and bloating . This gas and bloating places more pressure on the LES, increasing the probability that acid reflux will produce symptoms of heartburn.