Barrett’s Esophagus

If you have gastroesophageal reflux disease (GERD), and your symptoms are not well controlled, you’re at increased risk of developing Barrett’s esophagus. 

Barrett’s esophagus is caused by long-term, repeated exposure of the esophagus to stomach acid causing injury to the tissue in your esophagus. The esophageal tissue which is normally pale or pink and similar to skin tissue, turns red and thick (similar to the tissue that lines your intestine). This change is called intestinal metaplasia and is known as Barrett’s esophagus. 

Barrett’s esophagus happens most often where your esophagus meets your stomach. With GERD, the valve that connects your stomach to your esophagus, called the lower esophageal sphincter (LES), may get weak. When that happens, stomach contents (including stomach acid) may enter the esophagus causing injury. 

Not all people with GERD develop Barrett’s esophagus. Early diagnosis of GERD and its early treatment can decrease the risk of developing Barrett’s esophagus. However, if you’re not treating GERD properly, stomach acid can keep backing up into your esophagus. So, over time, your risk for Barrett’s esophagus increases.

Barrett’s esophagus can lead to precancerous cells in your esophagus, in turn, increasing your risk of a type of cancer called esophageal adenocarcinoma. 

Your risk of this type of cancer may be low. Each year, about one in 200 people who have Barrett’s esophagus are diagnosed with esophageal cancer. If you have the condition, you have a 5 to 10% chance of developing esophageal cancer in your lifetime.

Still, if you have Barrett’s esophagus, it’s important to monitor and manage it to minimize your risk of cancer.

What increases your risk of Barrett’s esophagus?

A long history of GERD puts you at higher risk. You’re also at higher risk if you:

• Have a close family member who had Barrett’s esophagus or esophageal cancer
• Are white and non-Hispanic
• Are male
• Are over age 50
• Are overweight
• Smoke

Symptoms of Barrett’s esophagus

If you have Barrett’s esophagus, you may not have any symptoms. Or you may notice GERD symptoms such as:

• Chronic heartburn 
• Acid regurgitation, especially when you are lying flat at night
• Difficulty swallowing or a feeling that food is stuck in your throat (called dysphagia)
• Chronic hoarseness or throat clearing

If you have these symptoms or have GERD and you’re concerned about Barrett’s esophagus, talk to your health care provider. You may also want to see a doctor who specializes in digestive problems, called a gastroenterologist. 

With screening and early detection, you can identify Barrett’s esophagus and start treating it before it leads to more serious conditions.

Get care right away for these symptoms:

• Chest pain
• Unintentional weight loss
• Vomiting blood
• Black or bloody stools

Diagnosing Barrett’s esophagus

For a diagnosis of Barrett’s esophagus, your provider will probably recommend endoscopy and biopsy:

• Endoscopy: A health care provider passes a thin, flexible tube with a camera (endoscope) down your throat to view the esophagus. With endoscopy, your provider can see the lining of the esophagus. This procedure may be a little uncomfortable, but you shouldn’t have any pain.
• Biopsy: During endoscopy, your provider may remove a small tissue sample (biopsy) to examine in a lab. With a biopsy, your provider may diagnose Barrett’s esophagus and see how much the cells in your esophagus have changed.

If you have Barrett’s esophagus, your biopsy may show:

• No dysplasia: Your cells don’t have precancerous signs.
• Low-grade dysplasia: Your cells show some precancerous signs.
• High-grade dysplasia: Your cells show a lot of precancerous signs and may soon become cancerous.

If you have GERD, your provider will probably want to monitor you closely to watch for signs of Barrett’s esophagus – even if you don’t have symptoms. That way, they can intervene and manage it as early as possible.

Screening for GERD might be recommended if you are male, have GERD symptoms at least weekly that don’t respond to medication and have other risk factors. Other people may need screening if they have uncontrolled reflux plus other risk factors.

If you have GERD, it’s a good idea to ask about screenings for Barrett’s esophagus during routine checkups. For example, talk to your provider when you schedule your routine colonoscopy screening. They may recommend scheduling an upper endoscopy at the same time to look for signs of Barrett’s esophagus. 

Even if you’ve only had brief GERD symptoms, or you take medication and feel your GERD is well-controlled, you should consider having an upper endoscopy with your colonoscopy. Screening is especially important if you use tobacco products or you are obese.

Your health care provider can talk to you about screening tests and schedule what you need based on your medical history. 

Treating Barrett’s esophagus

Medications and surgery can help treat chronic GERD, but they do not cure Barrett’s esophagus. Your provider may recommend treatment for GERD and an endoscopy in one to three years to look for changes.

If Barrett’s esophagus has progressed to a more dangerous form, you may need other treatments. 

Your health care provider may recommend different treatment options based on how severe your condition is, the changes in your cells, your overall health and your personal preferences. Options include:

• Endoscopic procedures: Treatments such as endoscopic mucosal resection (EMR), radiofrequency ablation (RFA), cryotherapy and photodynamic therapy can remove or destroy precancerous or abnormal cells in the esophagus. These procedures may reduce the risk of damage getting worse.
• Medications: Acid-reducing medications (such as proton pump inhibitors (PPIs)) help control reflux symptoms, making the esophagus less likely to be irritated. Histamine 2 (H2) blockers make your stomach produce less acid and may heal esophageal damage. Anti-inflammatory drugs may reduce inflammation.
• Surgery: In severe cases, your provider may recommend removing part of your esophagus and attaching the part that remains to your stomach.

Managing GERD 

It’s important to control GERD symptoms and reduce your risk of Barrett’s esophagus:

• If you have symptoms such as persistent heartburn, acid reflux or regurgitation, make an appointment with your provider to discuss them. Share your concerns and any lifestyle changes you’ve tried.
• Take your medication as prescribed and with plenty of water.
• Avoid trigger foods such as citrus, tomatoes, fatty and fried foods, chocolate, mint, coffee and alcohol.
• Eat smaller, more frequent meals and have your last meal four hours or more before bedtime.
• Maintain a healthy weight.
• Elevate the head of your bed by 30 degrees so stomach acid doesn’t flow into your esophagus while you sleep. 

Final thoughts

Barrett’s esophagus is a health condition that often develops if you have uncontrolled GERD for a long time. With it, the lining of your esophagus changes and may become precancerous. Quitting smoking and losing extra weight can help reduce your risk. Your provider can screen you for Barrett’s esophagus and recommend treatments if you need them.