Does Barrett Esophagus Cause Swallowing Difficulties?

Posted on Fri, 13 Jun 2014

Question: Hi,

I've been diagnosed with 6cm of Barrett's Esophagus (BE). There is no dysplasia, but I'm having trouble swallowing on and off for the past several months. One of my doctors indicated it may be the result of esophageal spasms. I've been through several tests, including endoscopies, barium/modified barium swallow study (with speech language pathologist in attendance), neurological exams including electromyelography and nerve conductivity studies, and video fluoroscopy. There is no indication that the swallowing issues are the result of neurological problems and two of the doctors suggested whatever is causing the problem is not oropharyngeal in nature, but more likely lower esophagus.

I've taken this information to my gastroenterologist, who said that swallowing difficulties are usually not the result of BE. But I'm reading materials in online medical journals and in books that are saying the exact opposite. I'm not sure that my gastro doc is right on this one.

So my questions are two:

1) Does BE cause trouble swallowing?

2) Is there any way to reverse BE? I've seen anecdotal reports in online forums of people who have had reversal of this condition within a couple of years of modifying their diet, quitting alcohol/smoking, and other lifestyle changes.

I'm at a point with the swallowing issues where I'm thinking of requesting radiofrequency ablation therapy and just paying for it out of pocket, if my insurance will not cover it. But if there is a chance of reversing the condition and clearing up this problem without any procedures, obviously that would be preferable. Thanks in advance for your time and consideration.

Answered by Dr. Achuo Ascensius (12 hours later)

Brief Answer:
your main trouble is acid reflux

Detailed Answer:
Hello,
thanks for the query
BE is caused by acid reflux. In severe and chronic acid reflux conditions, irritation from the acid could spread up to the pharynx causing some swallowing difficulties or pain.

I have not seen any scientific literature suggesting that BE is reversible. Treatment is aimed at slowing the progression. However, it could be hypothesized that if the acid reflux is prevented and with progressive replacement of cells of the esophageal lining, BE condition could improve.

Radiofrequency ablation would not do you much good especially given the fact that your BE does not have dysplasia. Your main treatment has to be focused on controlling the acid reflux.

I see you have used a lot of drugs all of which are main to reduce the acidity rather than specifically address the underlying reflux.

Acid reflux management needs a lot of diet control, modification of habits etc.
you will need to:
-avoid fatty food, spicy food, caffeinated drinks, chocolates, alcohol, tobacco
-loose weight,
-use a pillow to sleep
-let time between last meal and going to bed be at least 3 hours
-take medications with much water
-avoid eating too much
-avoid acidic food stuff such as lemon, oranges etc

Other drugs (prokinetic drugs)could be added to accelerate movement of food and secretions in the intestine. This could be prescribed and added to some of the drugs you have been on by your treating doctor or gastroenterologist.

Hope i have answered your query. If you have further query i will be glad to answer.

Best regards
Dr Achuo

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj