Answer

Gastroesophageal reflux disease (GERD) occurs when stomach acid and contents flow back into the esophagus, causing a burning sensation in the throat, heartburn, and discomfort. If prolonged, this condition can damage the esophageal lining, leading to the formation of Barrett's esophagus. This is a condition where the mucosal lining at the junction of the esophagus and stomach changes color, often appearing pinker than the normal esophageal lining.

Barrett's esophagus is considered a lesion with the potential to progress to esophageal adenocarcinoma. However, not everyone with long-standing reflux develops Barrett's esophagus, and not all cases progress to cancer.

Doctor Khanh examines and advises a patient on gastroesophageal reflux disease. Illustration: Tam Anh General Hospital.

This risk depends on various factors such as age, gender, family history, overweight status, smoking, and alcohol consumption. Overall, the rate of reflux progressing to Barrett's and then to cancer is low among Vietnamese and Asian populations.

The risk of cancer is associated with the type of Barrett's esophagus. The longer the Barrett's segment, the higher the risk of progression to esophageal adenocarcinoma. Barrett's is classified by length into two forms: long-segment Barrett's when the mucosal changes are 3 cm or more in length, and short-segment Barrett's when they are less than 3 cm.

Mucosal changes less than 1 cm on endoscopy are classified as ultra-short Barrett's (according to Japanese classification), which carries almost no risk of progressing to cancer and is not considered an indication for regular monitoring or cancer screening.

While you have Barrett's esophagus, continuous endoscopy is not always necessary, especially if there are no specific risk factors. Barrett's esophagus does not change significantly in just a few months. You should consult a doctor for an assessment to determine the frequency of endoscopy based on the length of the Barrett's segment, histopathology results, and the extent of esophageal damage.

Treatment varies by case. For patients without clear symptoms or severe esophageal damage, doctors will consider their specific condition to decide whether reflux medication is needed. In contrast, individuals with severe reflux esophagitis (grade C or D) may require long-term acid-suppressing medication, as damage can quickly recur if treatment is stopped; however, this group represents a very small percentage.

Doctor Vu Truong Khanh

Head of Department of Gastroenterology, Hepatology, and Pancreatology

Tam Anh General Hospital Hanoi