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The Massachusetts General Hospital Barrett’s Esophagus Treatment Center provides definitions of terms associated with Barrett’s esophagus symptoms, diagnosis and treatment.
Ablation: Removal or destruction of abnormal tissue. Two types of ablation for Barrett's esophagus are radiofrequency ablation and cryotherapyAcid: A chemical made by the stomach to help digest food. Reflux of acid into the esophagus is a strong contributor to the development of Barrett’s esophagus. Medical therapy of gastroesophageal reflux disease (GERD) is geared towards suppressing the stomach’s ability to make acid.Adenocarcinoma: The most common type of esophageal cancer in the United States. Anesthesiologist: Physician specializing in providing safe and adequate levels of sedation or anesthesia during an endoscopic or surgical procedure. Anti-reflux surgery: Surgery performed to improve the function of the lower esophageal sphincter, located between the esophagus and the stomach, and the mechanical valve that limits reflux of gastric contents into the esophagus. The most common type of anti-reflux surgery is a fundoplication, in which part of the stomach is wrapped around the lower esophagus.
Barrett's esophagus: A precancerous condition of the esophageal lining caused by chronic acid reflux. A short segment is less than 3 cm in length, a long segment is 4 cm to 10 cm in length, and a very long segment is more than 10 cm in length. Read frequently asked questions about Barrett’s esophagusBile: A chemical made by the liver and excreted into the small intestine. Reflux of this chemical into the esophagus may play a role in causing Barrett’s esophagus by causing inflammation of the tissue.Biopsy: Small (less than 5 mm) tissue sample taken at the time of endoscopy to determine the presence and/or stage of Barrett’s esophagus.Colon: The large intestine, responsible for forming stool.Cryotherapy: Form of Barrett's ablation using a low temperature liquid nitrogen application to the affected area of the esophagus. Learn more about cryotherapyDilation: An endoscopic technique to stretch out a narrowed esophagus.Dysphagia: Difficulty swallowing.Dysplasia: Abnormal tissue cells, which are considered an immediate precursor to cancer cells. Two types are low-grade and high-grade.Endoscopy: Diagnostic test in which a thin, flexible tube with a camera on the end is swallowed by the patient to allow the physician to directly inspect the lining of the upper gastrointestinal tract. Learn more about endoscopyEndoscopic ultrasound: An endoscopic exam in which ultrasound is used to examine all of the esophagus and surrounding tissue. This is performed in patients with dysplasia or early cancer before treatment. The exam is used to look for invasive disease and growth of the Barrett's esophagus into lymph nodes.Endoscopic Mucosal Resection (EMR): An endoscopic technique for removal of large pieces of tissue for diagnostic and treatment purposes. Learn more about EMREsophagectomy: A surgical procedure that involves removing the patient's esophagus and top part of the stomach. A portion of the stomach is then pulled up into the chest and connected to the remaining portion of the esophagus. The patient then has a "new" esophagus. Learn more about esophagectomy Esophageal cancer: Associated with Barrett's esophagus. The most common form is adenocarcinoma.Esophagus: Muscular tube that carries food, liquids and saliva from the mouth to the stomach through coordinated contractions of its muscular wall.
Gastroenterologist: Physician who specializes in diagnosis and treatment of gastrointestinal tract disorders including the esophagus, stomach, small intestine, large intestine, pancreas, liver, gallbladder and biliary system.Gastroesophageal Reflux Disease (GERD): Also called acid reflux disease, GERD is the regurgitation of stomach contents into the esophagus. Almost everyone experiences reflux at some time. The most common symptom is heartburn, usually occurring after a meal. In some people, reflux is frequent or severe enough to cause more significant problems.
General anesthesia: Deep level of sedation provided by an anesthesiologist during a procedure. This is required for some patients undergoing endoscopy and endoscopic ablation. All patients undergoing esophagectomy will have general anesthesia.
Goblet cells: The characteristic cell type seen in patients with Barrett’s esophagus. This confirms the presence of intestinal metaplasia and allows pathologists to make a diagnosis of Barrett's esophagus.Guideline: Recommendations about diagnosis and management made by expert physicians.High-grade dysplasia (HGD): The most advanced stage of dysplasia with unusual changes in many of the cells and an abnormal, distorted growth pattern. The cells are contained within the lining of the esophagus and have not spread to other areas. High-grade dysplasia indicates an increased risk of developing cancer of the esophagus, but not all people with HGD will develop cancer.Histamine blocker: Also known as a histamine receptor blocker (or H2 receptor blocker). These are oral antacid medications used for mild-to-moderate GERD. Generally, these are not as strong as the proton pump inhibitor (PPI) medications.Hoarseness: Change in the voice, which may be a sign of reflux.Intestinal metaplasia: Pathologist’s term for Barrett's esophagus. Intestinal metaplasia, also known as IM, is the least serious stage of Barrett's esophagus. The tissue in the esophagus has begun to change genetically and resembles the lining of the stomach rather than the normal lining of the esophagus.Intramucosal carcinoma: the earliest stage of esophageal cancer, limited to the top layers of the esophagus. This stage may be treated endoscopically or surgically.Invasive carcinoma: later stage of esophageal cancer involving deeper layers of the esophagus and/or lymph node tissue. This stage requires surgery and/or chemotherapy and radiation to manage optimally.Low-grade dysplasia (LGD): Unusual changes in some cells but the growth pattern of the cells remains normal. Less than 50% of the abnormal cells have begun to change in size, shape or organization and may show an increase in their growth rate. The cells are contained within the lining of the esophagus and have not spread to other areas.Lower esophageal sphincter (LES): the muscular valve at the junction of the esophagus and stomach. Abnormal relaxation of this valve is associated with GERD.Lymph node: normal tissue that exists outside of the esophagus and stomach and is part of the normal lymphatic system of the body, which helps clear the blood of infection. Lymph nodes are common sites of the spread of esophageal cancer. Evaluation of lymph nodes can be done with special X-rays or endoscopic ultrasound.
Minimally invasive esophagectomy: Esophagectomy using small incisions. This procedure is associated with better recovery times than traditional esophagectomy. Learn more about esophagectomy
Mucosa: The lining of the esophagus. Normal lining is known as squamous.Nodule: Small growth in the lining of the esophagus (also known as a growth). These typically harbor high-grade dysplasia or early cancer and may be removed endoscopically.Non-dysplastic Barrett’s esophagus (NDBE): The most common form of Barrett’s esophagus. The cells do not show precancerous changes. Patients are treated for GERD and undergo surveillance endoscopy every two to three years.Pathologist: A physician trained in the evaluation of tissue under a microscope. Perforation: A rare complication of endoscopic treatment of Barrett’s esophagus in which a transmural defect hole develops in the esophagus. This is usually repaired by endoscopic techniques or surgical procedure.Prospective: Study method in which two treatments are compared head-to-head in an ongoing fashion.Proton pump inhibitors (PPI): Class of strong antacid medications used to treat GERD. These drugs suppress acid production by the stomach. In Barrett’s esophagus, high doses, twice daily are often used. Examples include omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid).
Radiofrequency ablation (RFA): A form of endoscopic ablation in which heat is applied to the Barrett’s esophagus causing destruction of the infected tissue. Learn more about RFAReflux esophagitis: Inflammation of the lining of the esophagus caused by recurrent exposure to acid and/or bile reflux. If untreated over time, may lead to Barrett’s esophagus.Regurgitation: Movement of partially digested food or liquid from the stomach up into the esophagus.Retrospective: A study method in which two treatments are compared on the basis of previously collected data. Not as effective as a prospective to determine the superiority of one treatment over another.Screening: An evaluation of the lining of the esophagus to determine if Barrett's esophagus is present. This is best performed in high-risk patients, such as those with chronic GERD.
Sedation (deep): Patients are provided with enough anesthesia to allow completion of most endoscopic procedures. Breathing tubes are not required for this. Anesthesiologists or nurse anesthetists provide deep sedation.Small intestine: A digestive organ below the stomach. Typical length of 20 to 25 feet. Responsible for carrying bile into the gastrointestinal (GI) tract and for absorbing nutrients from food.Squamous mucosa: Normal lining of the esophagus.Squamous cancer: Form of esophageal cancer. Barrett’s esophagus does not lead to squamous cancer. Tobacco and alcohol use are associated with squamous cancer.Stomach: Digestive organ located below the esophagus. Responsible for making acid and the beginning phase of food digestion.Stricture: An uncommon complication of endoscopic treatment of Barrett’s esophagus in which the lining of the esophagus narrows and may lead to trouble swallowing. Dilation is required in this case.
Surveillance: An upper endoscopy procedure performed on a regular basis for patients with known Barrett’s esophagus. The goal of surveillance is to detect progression to more severe stages of disease or cancer. The frequency at which a patient undergoes surveillance may be dependent upon the stage (severity) of his/her Barrett's esophagus.
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