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What is Barrett's Esophagus?

Barrett's esophagus is a condition in which normal tissue lining of your esophagus – the tube that carries food from the mouth to the stomach – becomes more like the lining of your intestine, or thicker and red. Experts suspect that damage from acid reflux may be linked to the condition.

A few things happen in your body that result in Barrett's esophagus. Between the esophagus and the stomach, there is a valve called the lower esophageal sphincter (LES). It keeps stomach contents from rising up into the esophagus and prevents a back flow (reflux) of stomach acid. Over time, the LES can begin to stop working and lead to acid and chemical damage of the esophagus, called gastroesophageal reflux disease (GERD). 

In people with chronic symptoms of GERD, the acid reflux of GERD can then damage the esophageal lining, causing Barrett's esophagus.

Who gets Barrett's disease?

 In North America, there are about 30 million people who have GERD, the most common long-term gastrointestinal disease. Barrett's esophagus will happen in about 5% of patients with ongoing GERD or esophagus inflammation. 

Most people with acid reflux don't develop Barrett's esophagus. But in patients with frequent acid reflux, the normal cells in the esophagus may eventually be replaced by cells that are similar to cells in the intestine to become Barrett's esophagus.

Also, not everyone with GERD develops Barrett's esophagus. And not everyone with Barrett's esophagus has GERD. But long-term GERD is the primary risk factor.

Barrett's esophagus is a condition in which normal tissue lining the esophagus – the tube that carries food from the mouth to the stomach – becomes thicker and red. Experts suspect that damage from acid reflux may be linked to the condition. (Photo Credit: Ihor Vinicenko/Dreamstime)

Barrett's Esophagus Symptoms

Barrett's esophagus does not have any specific symptoms, although people with Barrett's esophagus may have symptoms similar to those who have GERD, which can include:

Barrett's Esophagus Risk Factors

While the condition is rare overall, there are a number of things that can make you more likely to get Barrett’s esophagus. One is the start of GERD at a younger age, if you've had heartburn symptoms for 10 years or more.

Other risk factors include:

How Is Barrett's Esophagus Diagnosed?

Because there are often no specific symptoms linked to Barrett's esophagus, it can only be diagnosed with an upper endoscopy and biopsy. Guidelines from the American Gastroenterological Association recommend screening in people who have multiple risk factors for Barrett’s esophagus. 

To perform an endoscopy, a doctor called a gastroenterologist inserts a long flexible tube with a camera attached down the throat into the esophagus after giving the patient a sedative. The process may feel a little uncomfortable, but it isn't painful. Most people have little or no problem with it.

Once the tube is inserted, the doctor can visually inspect the lining of the esophagus. Barrett's esophagus, if it's there, is visible on camera, but the diagnosis requires a biopsy. The doctor will remove a small sample of tissue to be examined under a microscope in the laboratory to confirm a diagnosis.

The sample will also be examined for the presence of precancerous cells or cancer. If the biopsy confirms the presence of Barrett's esophagus, your doctor will probably recommend a follow-up endoscopy and biopsy to examine more tissue for early signs of cancer.

If you have Barrett's esophagus but no cancer or precancerous cells are found, the doctor will still most likely recommend that you have periodic endoscopies. This is a precaution, because cancer can develop in tissue years after Barrett's esophagus is diagnosed. If precancerous cells are present in the biopsy, your doctor will discuss treatment options with you.

Complications

A diagnosis of Barrett's esophagus is not a cause for major alarm. But Barrett's esophagus can lead to precancerous changes in a small number of people.

If you have Barrett's esophagus, there is a very small increase in the risk of getting esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus (less than 1% of people with Barrett's esophagus). 

You'll want to have regular checkups so your doctor can look for precancerous and cancer cells early, before they can spread and when the disease is easier to treat.

 

Barrett's Esophagus Treatments

A main focus of treatment for Barrett's esophagus is to prevent or slow the development of the condition, which can be achieved with certain procedures and medications.

Several treatments, including surgery, are designed specifically to focus on the abnormal tissue. They will vary, depending on your overall health and the presence of precancerous cells, or dysplasia, in your esophagus.

No dysplasia

Normal endoscopy. This is a procedure in which your doctor will send a lighted tube with a camera at the end – also known as an endoscope – down your throat to check your esophagus. Your doctor will likely want you to have an endoscopy every 2 to 3 years.

Your doctor may also prescribe medications or other things that are commonly used to treat GERD to help, which could include:

Low-grade dysplasia

If you're diagnosed with low-grade dysplasia – the early stage of precancerous changes – it means only some of your cells are abnormal, but most are not. Your doctor could recommend more checkups, about every six months to a year, to check for more changes. They may also suggestablation therapy, which is a minimally invasive procedure to destroy abnormal tissue.

High-grade dysplasia

This form of dysplasia is known as the precursor to esophageal cancer. Your doctor may recommend more frequent checkups and treatment to remove damaged tissue, including:

Radiofrequency ablation (RFA). This most common procedure uses radio waves delivered through an endoscope inserted into the esophagus to destroy abnormal or cancerous cells in the Barrett's tissue while protecting the healthy cells underneath.

Endoscopic mucosal resection (EMR). EMR lifts the abnormal lining and cuts it off the wall of the esophagus before it's removed through the endoscope. The goal is to remove any precancerous or cancer cells contained in the lining. If cancer cells are present, an ultrasound is done first to be sure the cancer hasn't moved deeper into the esophagus walls.

Endoscopic spray cryotherapy. This is a newer technique that applies cold nitrogen or carbon dioxide gas through the endoscope to freeze and destroy the abnormal cells.

Photodynamic therapy (PDT). A laser through an endoscope kills abnormal cells in the lining without damaging normal tissue. Before the procedure, the patient takes a drug known as Photofrin, which causes cells to become light-sensitive. Your doctor may combine this with endoscopic mucosal resection.

Surgery. There are a couple of ways your doctor could use surgery as treatment. They may remove the affected part of your esophagus, then rebuild it from part of your stomach or large intestine. Removing most of the esophagus is an option in cases where severe precancer (dysplasia) or cancer has been diagnosed. The earlier the surgery is done after the diagnosis, the better the chance for the cure. 

Lifestyle and Home Remedies

Another treatment goal is to control acid reflux, which can be done with lifestyle changes. You can try to: