What is Barrett’s esophagus?
Barrett’s esophagus occurs when the cells lining the esophagus change into cells that look like the cells that line the inside of the stomach and small intestine. The name for this is intestinal metaplasia. It affects the lower part of the esophagus where it meets the stomach. When doctors examine the inside of the esophagus, they can see a marked transition between normal, smooth, pink lining and the more irregular and darker lining of the esophagus. They will perform a biopsy to make a definitive diagnosis of Barrett’s esophagus. Another name for this condition is Barrett’s syndrome.
People who have Barrett’s esophagus have a slightly increased risk of developing esophageal cancer. There are two main types of esophageal cancer—squamous cell and adenocarcinoma. Squamous cell is more common in people who smoke and consume alcohol. Adenocarcinoma is the form that occurs with Barrett’s esophagus. However, most people with Barrett’s esophagus will not get esophageal cancer.
Barrett’s esophagus most commonly affects people who have suffered with GERD (gastroesophageal reflux disease) for many years. GERD is chronic reflux of stomach acid into the esophagus resulting in heartburn and other symptoms. Older, Caucasian men with long-standing heartburn have the highest risk of Barrett’s esophagus.
The necessity for Barrett’s esophagus treatment depends on the biopsy results. If your doctor sees precancerous changes, you may need endoscopic treatment to destroy the tissue. Doctors rarely recommend Barrett’s esophagus surgery due to the success of endoscopic treatments. Surgery was a more common treatment in the past.
If you have chronic heartburn or GERD, talk with your doctor about your risk of Barrett’s esophagus. See your doctor promptly if you have concerning symptoms, including trouble swallowing, vomiting, blood in stool, or unintended weight loss. These symptoms may indicate a more serious condition.
What are the symptoms of Barrett’s esophagus?
There are no Barrett’s esophagus symptoms. However, most people with Barrett’s esophagus have had GERD for a long time.
Common symptoms of GERD
The most common symptoms of GERD are:
Frequent heartburn causing pain, discomfort or burning in the chest
Regurgitation of stomach contents or sour liquid
Swallowing problems or feeling lump in the throat
If you have had GERD for many years, ask your doctor about Barrett’s esophagus. Find out if you need an endoscopy to look at the inside of your esophagus. This test involves putting a thin, lighted tube down your throat and into your stomach. The tube—or endoscope—has a camera that allows your doctor to view the esophageal lining. If your doctor sees changes in the lining, he or she will take a biopsy. A biopsy is the only way to diagnose Barrett’s esophagus.
A biopsy will also tell your doctor about your risk of developing esophageal cancer. The lab that examines the tissue will report on the level of dysplasia in the sample. Dysplasia is a precancerous condition. It describes how differently the cells look and grow compared to normal cells. If dysplasia is present, the grade or amount of change will guide your doctor’s recommendations for treatment and follow-up. A second pathologist should verify the presence of dysplasia. A second opinion can help you and your doctors be confident with the diagnosis and treatment plan.
What causes Barrett’s esophagus?
Barrett’s esophagus causes are not fully understood. Most, but not all people with the condition also have GERD. GERD causes damage and chronic inflammation of the esophageal lining. As the body makes repairs, the cells in the lining change. Instead of the lining looking smooth and pink, the lining appears darker with an irregular surface. The cells that make up the esophageal lining more closely resemble the cells lining the stomach and small intestine.
What are the risk factors for Barrett’s esophagus?
There are several factors that increase the risk of developing Barrett’s esophagus. Having GERD is an important one. About 10 to 15% of people with GERD will develop Barrett’s esophagus. The risk increases when you have had GERD or heartburn symptoms for 10 years or longer. Other risk factors for Barrett’s esophagus include:
Age: Older adults have a higher risk of Barrett’s esophagus. Doctors commonly diagnose it when people are in their 60’s.
Race: It is about 10 times more common in Caucasians compared to African Americans.
Sex: The risk is 3 to 4 times higher in men than women.
Lifestyle factors may also increase your risk of Barrett’s esophagus. Being overweight and smoking are the two main ones linked to the condition. Carrying extra weight in your belly or abdomen seems to be a risk factor. Both current and former smokers carry a higher risk as well.
Reducing your risk of Barrett’s esophagus
You may be able to lower your risk of Barrett’s esophagus by:
Maintaining a healthy body weight
Never smoking or stopping if you currently smoke
Treating GERD and heartburn to prevent damage to the esophagus
If you have uncontrolled heartburn, let your doctor know. Taking medicines to control acid reflux can help control your symptoms and may decrease your risk of Barrett’s esophagus. Changing your diet can also help reduce reflux.
How is Barrett’s esophagus treated?
For people with GERD and Barrett’s esophagus, doctors typically recommend medicine to control GERD. If you do not already take medicine, your doctor will likely prescribe a proton pump inhibitor (PPI). These drugs decrease the amount of acid your stomach makes. Other treatments, such as surgery, may be necessary depending on your situation. However, treatments for GERD will not treat or change Barrett’s esophagus.
The main treatment for Barrett’s esophagus is eliminating the tissue with an endoscopic procedure. There are several ways to destroy the tissue including:
Cryoablation using cold energy
Photodynamic therapy using light energy
Thermal ablation using heat energy, such as radiofrequency ablation and others
In rare cases, doctors surgically remove the Barrett’s esophagus tissue. Endoscopic treatments have largely eliminated the need for Barrett’s esophagus surgery.
Whether you need treatment will depend on the amount of dysplasia you have:
No dysplasia means the cells look and act normally. People without dysplasia do not need to treat Barrett’s esophagus. Instead, doctors use endoscopy to monitor for any disease progression. This is usually necessary every 3 to 5 years.
Low-grade dysplasia means the cells look abnormal and have partially replaced the normal cells. People with low-grade dysplasia can choose to treat it or monitor it. If you do not treat it, you will need frequent follow-up endoscopies, usually every 6 to 12 months. Your doctor can help you decide on the best course of action for you.
High-grade dysplasia means the cells are very abnormal and have nearly replaced all of the normal cells. Experts believe high-grade dysplasia is precancerous. Treatment is necessary to remove the tissue.
What are the potential complications of Barrett’s esophagus?
The two main complications of Barrett’s esophagus are recurrence of the condition and esophageal cancer. Despite the association with esophageal cancer, the incidence of cancer is low. About 1 in 200 people with Barrett’s esophagus will develop esophageal cancer per year. This is 0.5%. That’s why the diagnosis—even with low-grade dysplasia—does not always mean treatment is necessary. The more dysplasia you have, the higher the risk of it turning into cancer. However, other factors can also influence your risk of esophageal cancer.
If you have Barrett’s esophagus, talk with your doctor about your risk of cancer and your treatment options.