This information explains the causes, diagnosis, and treatment of Barrett’s esophagus.
About Barrett’s Esophagus
The esophagus is the tube that carries food and liquids from your mouth to your stomach (see Figure 1). The cells that line your esophagus are called squamous cells. In Barrett’s esophagus, these cells are replaced by a type of cell not usually found in the esophagus. These new cells look more like the cells that line your intestines. This process is called intestinal metaplasia.
Having Barrett’s esophagus can increase the risk of developing esophageal cancer. Because of this, we recommend that you have regular medical check-ups and follow your treatment plan.Back to top
Causes and Risk Factors
The exact cause of Barrett’s esophagus is not known. Most people with Barrett’s esophagus have long-standing gastroesophageal reflux disease (GERD). GERD is when your stomach contents flow back into your esophagus. It is also called reflux. GERD can cause a burning feeling in the throat or chest known as heartburn.
Over time, the stomach acid and bile damage the lining of the esophagus. Some people with a history of GERD can develop Barrett’s esophagus if this damage is severe.
Most people who develop Barrett’s esophagus are usually:
- Older (Usually over the age of 40)
- Obese or overweight
Diagnosing Barrett’s Esophagus
Barrett’s esophagus is diagnosed with an endoscopy procedure. For the endoscopy, your doctor will use a flexible tube called an endoscope to see the inside of your esophagus on a video monitor (see Figure 2).
You will receive anesthesia (medication to make you sleepy) so you will not feel any discomfort. During your endoscopy your doctor will look for signs that your esophageal tissue is changing. Your doctor may also biopsy (take a sample of) the tissue from the lining of your esophagus. This sample will be sent to the pathology department to look for precancerous tissue (tissue that may become cancer). If your sample has precancerous tissue, this is called dysplasia. Your treatment for Barrett’s esophagus will be different if you have dysplasia.Back to top
Treatment for Barrett’s Esophagus
If you do not have dysplasia, Barrett’s esophagus can be treated with medication to treat GERD. These medications help reduce the acid in your stomach. They also may help prevent irritation to the esophagus. If medication does not improve your symptoms, you may need anti-reflux surgery. If you need the surgery, your doctor will discuss this with you.
Medication does not cure Barrett’s esophagus but it may help slow it down.
The treatment for Barrett’s esophagus will be different if you have dysplasia. Levels of dysplasia range from low-grade to high-grade. The level of dysplasia shows the cancer risk and helps your doctor decide the type of treatment needed.
- If you have low-grade dysplasia, the risk of it becoming cancer is low. However, the more areas with low-grade dysplasia you have, the higher the risk of it becoming cancer.
- If you have high-grade dysplasia, the risk of it becoming cancer is very high.
The 2 main types of treatment for dysplasia are endoscopic treatments and surgery.
Endoscopic treatments aim to destroy or remove the abnormal tissue without surgery. The types of endoscopic treatments include:
- Endoscopic mucosal resection (EMR): A salt solution may be injected under the abnormal tissue to raise it during the endoscopy exam. The tissue is then shaved off and examined.
- Radiofrequency ablation (RFA): A special device is passed down your esophagus. It gives short bursts of intense radio waves (heat) to destroy the abnormal tissue.
- Cryoablation: Extremely cold liquid and gas is delivered through the endoscope to freeze and destroy abnormal tissue.
- Photodynamic therapy (PDT): Light-sensitive medication and red laser light are used to kill abnormal tissue.
Your doctor may recommend that you have surgery to remove your esophagus. This is called an esophagectomy. Your doctor will tell you more about it if you need to have this done.Back to top
What You Can Do
If you have Barrett’s esophagus, your doctor will recommend treatment and follow-up exams. In addition, try to follow some lifestyle changes such as:
- Sitting up after meals
- Avoiding food 2 to 3 hours before bedtime
- Avoiding foods that cause acid such as caffeinated foods (coffee, teas, sodas, and chocolate) and alcohol
- Sleeping with the head of the bed elevated so your head is above your stomach
- Avoiding large, fatty meals
Speak with your doctor or nurse if you have any questions.Back to top
The National Digestive Disease Information Clearinghouse
National Cancer Institute
The American Society of Clinical Oncology