Barrett's esophagus is a condition in which the flat pink lining of the swallowing tube that connects the mouth to the stomach (esophagus) becomes damaged by acid reflux, which causes the lining to thicken and become red.
Between the esophagus and the stomach is a critically important valve, the lower esophageal sphincter (LES). Over time, the LES may begin to fail, leading to acid and chemical damage of the esophagus, a condition called gastroesophageal reflux disease (GERD). GERD is often accompanied by symptoms such as heartburn or regurgitation. In some people, this GERD may trigger a change in the cells lining the lower esophagus, causing Barrett's esophagus.
Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk of developing esophageal cancer is small, it's important to have regular checkups with careful imaging and extensive biopsies of the esophagus to check for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer.
The development of Barrett's esophagus is most often attributed to long-standing GERD, which may include these signs and symptoms:
Curiously, approximately half of the people diagnosed with Barrett's esophagus report little if any symptoms of acid reflux. So, you should discuss your digestive health with your doctor regarding the possibility of Barrett's esophagus.
If you've had trouble with heartburn, regurgitation and acid reflux for more than five years, then you should ask your doctor about your risk of Barrett's esophagus.
Seek immediate help if you:
The exact cause of Barrett's esophagus isn't known. While many people with Barrett's esophagus have long-standing GERD, many have no reflux symptoms, a condition often called "silent reflux."
Whether this acid reflux is accompanied by GERD symptoms or not, stomach acid and chemicals wash back into the esophagus, damaging esophagus tissue and triggering changes to the lining of the swallowing tube, causing Barrett's esophagus.
Factors that increase your risk of Barrett's esophagus include:
People with Barrett's esophagus have an increased risk of esophageal cancer. The risk is small, even in people who have precancerous changes in their esophagus cells. Fortunately, most people with Barrett's esophagus will never develop esophageal cancer.
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 will remove tissue (biopsy) from your esophagus. The biopsied tissue can be examined to determine the degree of change.
A doctor who specializes in examining tissue in a laboratory (pathologist) determines the degree of dysplasia in your esophagus cells. Because it can be difficult to diagnose dysplasia in the esophagus, it's best to have two pathologists — with at least one who specializes in gastroenterology pathology — agree on your diagnosis. Your tissue may be classified as:
The American College of Gastroenterology says screening may be recommended for men who have had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:
While women are significantly less likely to have Barrett's esophagus, women should be screened if they have uncontrolled reflux or have other risk factors for Barrett's esophagus.
Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health.
Your doctor will likely recommend:
Low-grade dysplasia is considered the early stage of precancerous changes. If low-grade dysplasia is found, it should be verified by an experienced pathologist. For low-grade dysplasia, your doctor may recommend another endoscopy in six months, with additional follow-up every six to 12 months.
But, given the risk of esophageal cancer, treatment may be recommended if the diagnosis is confirmed. Preferred treatments include:
If significant inflammation of the esophagus is present at initial endoscopy, another endoscopy is performed after you've received three to four months of treatment to reduce stomach acid.
High-grade dysplasia is generally thought to be a precursor to esophageal cancer. For this reason, your doctor may recommend endoscopic resection, radiofrequency ablation or cryotherapy. Another option may be surgery, which involves removing the damaged part of your esophagus and attaching the remaining portion to your stomach.
Recurrence of Barrett's esophagus is possible after treatment. Ask your doctor how often you need to come back for follow-up testing. If you have treatment other than surgery to remove abnormal esophageal tissue, your doctor is likely to recommend lifelong medication to reduce acid and help your esophagus heal.
Lifestyle changes can ease symptoms of GERD, which may underlie Barrett's esophagus. Consider:
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).
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
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:
