Barrett’s esophagus

In Barrett’s esophagus, tissue in the tube connecting your mouth and stomach (esophagus) is replaced by tissue similar to the intestinal lining.

Barrett’s esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett’s esophagus.

Barrett’s esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it’s important to have regular checkups for precancerous cells. If precancerous cells are discovered, they can be treated to prevent esophageal cancer.

The tissue changes that characterize Barrett’s esophagus cause no symptoms. The signs and symptoms that you experience are generally due to GERD and may include:

• Frequent heartburn
• Difficulty swallowing food
• Less commonly, chest pain

Many people with Barrett’s esophagus have no signs or symptoms.

When to see a doctor

If you’ve had trouble with heartburn and acid reflux for more than five years, ask your doctor about your risk of Barrett’s esophagus.

Seek immediate help if you:

• Have chest pain, which may be a symptom of a heart attack
• Have difficulty swallowing
• Are vomiting red blood or blood that looks like coffee grounds
• Are passing black, tarry or bloody stools

The exact cause of Barrett’s esophagus isn’t known. Most people with Barrett’s esophagus have long-standing GERD. In GERD, stomach contents wash back into the esophagus, damaging esophagus tissue. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett’s esophagus.

However, some people diagnosed with Barrett’s esophagus have never experienced heartburn or acid reflux. It’s not clear what causes Barrett’s esophagus in these people.

Factors that increase your risk of Barrett’s esophagus include:

• Chronic heartburn and acid reflux. Having GERD for more than five years or having GERD that requires regular medication and being older than age 50 can increase the risk of Barrett’s esophagus. Your risk may be further increased if you are age 30 or younger when chronic GERD develops.
• Age. Barrett’s esophagus can occur at any age but is more common in older adults.
• Being a man. Men are more likely to develop Barrett’s esophagus.
• Being white. White people have a greater risk of the disease than do people of other races.
• Being overweight. Body fat around your abdomen further increases your risk.
• Smoking.

People with Barrett’s esophagus have an increased risk of esophageal cancer. The risk is small, especially in people whose lab tests show no precancerous changes (dysplasia) in their esophagus cells. Most people with Barrett’s esophagus will never develop esophageal cancer.

Barrett’s esophagus is most often diagnosed in people with GERD who are being examined for GERD complications. If your doctor discovers Barrett’s esophagus on an endoscopy exam, you may be referred to a doctor who treats digestive diseases (gastroenterologist).

What you can do

• Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medications, vitamins and supplements.
• Write down your key medical information, including other conditions.
• Ask a relative or friend to accompany you to help you remember what the doctor says.
• Write down questions to ask your doctor.

Questions to ask your doctor

• Do my lab reports show abnormal tissue (dysplasia)? If so, what is the grade of my dysplasia?
• How much of my esophagus is affected?
• How often should I be screened for changes to my esophagus?
• What is my risk of esophageal cancer?
• What are the treatment options?
• Do I need to make diet or other lifestyle changes?
• I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you’ve prepared to ask your doctor, don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:

• When did you first begin experiencing symptoms? How severe are they?
• Are your symptoms continuous or occasional?
• What, if anything, seems to improve or worsen your symptoms?
• Do you experience acid reflux symptoms?
• Do you take any medications for reflux or indigestion?
• Do you have difficulty swallowing?
• Have you lost weight?

Diagnosing Barrett’s esophagus

Endoscopy is generally used to determine if you have Barrett’s esophagus.

A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing esophagus tissue. Normal esophagus tissue appears pale and glossy. In Barrett’s esophagus, the tissue appears red and velvety.

Your doctor is likely to remove a small tissue sample (biopsy). The biopsy can be examined to determine the degree of tissue change.

Determining the degree of tissue change

A doctor who specializes in examining tissue in a laboratory (pathologist) determines the degree of dysplasia in your esophagus cells. Your tissue may be classified as:

• No dysplasia, if Barrett’s esophagus is present but no precancerous changes are found in the cells.
• Low-grade dysplasia, if cells show small signs of precancerous changes.
• High-grade dysplasia, if cells show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.

Treatment for Barrett’s esophagus depends on the degree of dysplasia found in your esophagus cells and your overall health.

No dysplasia or low-grade dysplasia

Your doctor will likely recommend:

• Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you’ll probably have a follow-up endoscopy in one year and then every three years if no changes occur. If low-grade dysplasia is found, your doctor may recommend another endoscopy in six months or a year.
• Treatment for GERD. Medication and lifestyle changes can ease your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option. Treating GERD doesn’t treat the underlying Barrett’s esophagus but can help make it easier to detect dysplasia.

High-grade dysplasia

High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, your doctor may recommend:

• Endoscopic resection, which uses an endoscope to remove damaged cells.
• Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.
• Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then frozen again. The cycle of freezing and thawing damages the abnormal cells.
• Photodynamic therapy, which destroys abnormal cells by making them sensitive to light.
• Surgery in which the damaged part of your esophagus is removed and the remaining portion is attached to your stomach.

If you have treatment other than surgery to remove your esophagus, your doctor is likely to recommend medication to reduce acid and help your esophagus heal.

Lifestyle changes can ease symptoms of GERD, which may underlie Barrett’s esophagus. Consider:

• Maintaining a healthy weight.
• Avoiding tightfitting clothes, which can put pressure on your abdomen and aggravate reflux.
• Eliminating foods and drinks that trigger your heartburn.
• Stopping smoking.
• Avoiding stooping or bending, especially soon after eating.
• Avoiding lying down after eating. Wait at least three hours after eating to lie down or go to bed.
• Raising the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of 6 to 8 inches. Raising your head by using only pillows isn’t a good alternative.

If you’ve been diagnosed with Barrett’s esophagus, you may worry about your risk of esophageal cancer. The risk of developing cancer is very small. If you experience anxiety, consider:

• Activities that help you relax, such as exercise or listening to music
• Healthy lifestyle choices, to ease any GERD symptoms and improve your overall health

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