Barrett's Esophagus

What is Barrett's esophagus? Barrett’s esophagus is a change in the tissue lining your esophagus, the tube in your throat that carries food to your stomach. For reasons no one understands completely, cells in the esophageal lining sometimes become more like intestinal cells. Researchers suspect that having acid reflux or gastroesophageal reflux disease (GERD) is related to Barrett’s esophagus. Barrett’s esophagus raises the risk of developing a rare esophageal cancer.

Who gets Barrett’s esophagus? People who are more likely to develop Barrett’s esophagus: Are non-Hispanic white. Were assigned male at birth. Are middle-aged or older. Have obesity. They may also have: Family history of Barrett’s esophagus or esophageal cancer. Heartburn symptoms for 10-plus years. Gastroesophageal reflux disease (GERD).

How common is Barrett’s esophagus? On its own, Barrett’s esophagus doesn’t produce symptoms. You may discover you have it only after seeing your healthcare provider for gastroesophageal reflux disease (GERD) symptoms or after developing esophageal cancer. Because of the lack of symptoms, no one is sure how common it is. But experts estimate that Barrett’s esophagus affects about 1% of people.

What causes Barrett’s esophagus?

Multiple factors contribute to Barrett’s esophagus. It’s more common in people with GERD. This chronic (ongoing) condition occurs when stomach contents flow backward into the esophagus. Experts believe the acidic liquid irritates the lining of the esophagus, leading to changes in the tissue. But you can also have Barrett’s esophagus without having GERD.

What are the symptoms of Barrett’s esophagus?

Barrett’s esophagus does not cause symptoms. But you can watch for signs of the conditions it’s associated with — heartburn and acid regurgitation.

Heartburn that occurs at least twice a week is the biggest red flag. Heartburn symptoms include a burning sensation in the chest and vomit in the back of the throat (acid regurgitation).

Other symptoms to watch for include:

- Heartburn that worsens or wakes you from sleep.

- Painful or difficult swallowing.

- Sensation of food stuck in your esophagus.

- Constant sore throat, sour taste in your mouth or bad breath.

- Unintentional weight loss.

- Blood in stool.

- Vomiting.

How is Barrett's esophagus diagnosed?

The only way to confirm the diagnosis of Barrett's esophagus is with a test called an upper endoscopy. This involves inserting a small lighted tube (endoscope) through the throat and into the esophagus to look for a change in the lining of the esophagus.

While the appearance of the esophagus may suggest Barrett's esophagus, the diagnosis can only be confirmed with small samples of tissue (biopsies) obtained through the endoscope. A pathologist will examine the tissue to make the diagnosis.

How is Barrett’s esophagus treated?

Your treatment depends largely on presence of symptoms and dysplasia on biopsies:

Barrett’s esophagus without dysplasia

Having Barrett’s esophagus without dysplasia means your provider didn’t detect precancerous cells. Usually, you don’t need treatment at this stage. But your healthcare provider will want to monitor the condition. You’ll need to have an upper endoscopy every two to three years.

If you have GERD, your healthcare provider may prescribe medications to treat GERD. These medicines decrease stomach acid, which can protect your esophagus from damage. Lifestyle changes, like sleeping slightly inclined and avoiding eating dinner late, often help, too.

Barrett’s esophagus with dysplasia

Dysplasia is the presence of precancerous cells. Your doctor may recommend frequent monitoring or treatment to prevent cancer from developing.

Low-grade dysplasia

Low-grade dysplasia means you have some abnormal cells, but the majority aren’t affected. In this case, you may just need frequent checks to see if more changes occur. Expect to undergo an upper endoscopy every six months to a year. Ablation therapy is also recommended in select patients.

High-grade dysplasia

High-grade dysplasia indicates a substantial change in your esophagus lining. With this diagnosis, cancer is more likely. You may need to repeat upper endoscopies more often to look for cancer. Your provider may also recommend treatment, which focuses on removing the damaged tissue and includes:

Radiofrequency ablation: This is the most common procedure. It burns off abnormal tissue using radio waves, which generate heat.

Cryotherapy: Healthcare providers use liquid nitrogen to freeze diseased parts of the esophagus lining so it will slough off (shed). The process is similar to how dermatologists “freeze off” a wart.

Endoscopic mucosal resection: Using an endoscope, your provider can remove precancerous spots on the esophagus lining.

Surgery: If you have severe dysplasia or esophageal cancer, your provider may recommend an esophagectomy, a surgery to remove all or part of the esophagus.