Barrett's Esophagus

Overview

Barrett’s esophagus happens when the tissue lining the esophagus, or the swallowing tube, has changed into tissue similar to the lining of the intestines. It’s thought to be caused by long-term exposure to stomach acid. The abnormal tissue is often found where the esophagus meets the stomach.

Barrett’s esophagus increases the risk for esophageal cancer. However, most people do not develop cancer. If you have this condition, you should be monitored closely for cancer signs and symptoms.

Barrett’s esophagus causes

Doctors don’t know the exact cause of Barrett’s esophagus.

It may be related to chronic (ongoing) gastroesophageal reflux disease (GERD). GERD happens when stomach acids back up into the esophagus. Over time, the lining of the esophagus becomes damaged, which causes the cells to change.

Still, only a small percentage of people with GERD develop Barrett’s esophagus. Sometimes the cause is unknown.

Barrett’s esophagus risk factors

While people at any age can have Barrett’s esophagus, it mostly affects adults over age 55. It also appears to happen more in Caucasians, and in men more than women.

In addition to having long-lasting GERD, factors that may increase your risk for Barrett’s esophagus include:

• Being obese
• Having chronic heartburn
• Having H pylori gastritis
• Smoking (current or past)

Other factors can worsen GERD and Barrett’s esophagus, such as:

• Drinking alcohol
• Eating large meals
• Having a diet high in saturated fats
• Laying down after eating
• Using NSAIDs or aspirin frequently

Barrett’s esophagus symptoms

Changes in the esophagus lining can happen without causing symptoms. However, people with Barrett’s esophagus often have symptoms that are similar to GERD, which may include:

• Bloody stools
• Chest pain
• Frequent heartburn
• Pain where the esophagus meets the stomach
• Regurgitation, or spitting up undigested food or liquid
• Throwing up blood
• Trouble swallowing (called dysphasia)
• Weight loss

 Barrett’s esophagus diagnosis

Doctors use endoscopy to diagnose and stage Barrett’s esophagus. This involves placing a flexible, thin tube with a camera at the end — called an endoscope — into the esophagus. At this time, the doctor can take a small tissue sample using a tool passed through the tube.

The tissue sample, called a biopsy, is then viewed under a microscope. Barrett’s esophagus is diagnosed and staged based on how much the tissue has changed. Stages range from low grade dysplasia (non-cancerous) to high grade dysplasia (may become cancerous).

Based on your results, you may need other tests such as an endoscopic ultrasound, a CT scan or a PET scan.

Barrett’s esophagus treatment

Treating Barrett’s esophagus depends on the stage. In general, treatment is aimed at destroying or removing the abnormal tissue to reduce the risk of it turning into cancer.

If no cancerous changes are found, your doctor may recommend regular follow-up diagnostic endoscopy to watch for symptoms.

When needed, there are a number of non-surgical endoscopic therapies available. Endoscopic therapies involve inserting a flexible tube into the esophagus and using tiny tools to perform certain procedures, including:

• Cryotherapy, which uses cold gas or liquid to freeze the tissue.
• Mucosal resection, which includes shaving off the abnormal tissue.
• Photodynamic therapy, which involves a light-sensitive drug and a laser.
• Radiofrequency ablation, which uses heat to burn the tissue.

In some cases, surgery may be required.

When to seek care

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a gastroenterologist or a surgeon for more specialized treatment.