Barrett’s Esophagus

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

Barrett’s esophagus develops after long-term, repeated exposure of the esophagus (swallowing tube) to stomach acid, which damages the tissue. The tissue lining the esophagus is normally pale or pink and similar to skin tissue. In Barrett's esophagus, it becomes red and thick, similar to the tissue that lines the intestine. This change is called intestinal metaplasia and is known as Barrett’s esophagus. 

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

Not everyone with GERD develops Barrett’s esophagus. Early diagnosis of GERD and its early treatment can decrease the risk of developing Barrett’s esophagus. However, if GERD is not treated properly, stomach acid can continue to back up into the esophagus. So, over time, your risk for Barrett’s esophagus increases.

Barrett’s esophagus can lead to precancerous cell changes in the esophagus, which increases the risk of esophageal adenocarcinoma. 

For most people, the risk of this type of cancer is low. Each year, about one in 200 people who have Barrett’s esophagus are diagnosed with esophageal cancer. If you have Barrett's esophagus, your lifetime risk of developing esophageal cancer is about 5% to 10%.

Even so, monitoring and managing Barrett’s esophagus is important to help reduce cancer risk.

What increases the 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 family history of 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

Many people with Barrett’s esophagus do not have 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 are 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. 

Screening and early detection can help identify Barrett’s esophagus before it leads to more serious conditions.

Get medical care right away if you have:

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

How Barrett’s esophagus is diagnosed

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 feel uncomfortable, but it should not be painful.
• 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, biopsy results 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. This allows your provider to manage the condition as early as possible.

Screening may 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 scheduling a routine colonoscopy. 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. 

How Barrett’s esophagus is treated

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 disease progression.
• 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 reduce stomach acid production and may help 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 symptoms

Controlling GERD symptoms can help reduce the 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 about 30 degrees to help prevent stomach acid from flowing into your esophagus while you sleep. 

Final thoughts

Barrett’s esophagus often develops after long-term, uncontrolled GERD. 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 recommend screening and treatment options based on your risk and medical history.