Most people are familiar with heartburn and the discomfort it brings. But they may not be aware that it can be a sign of gastroesophageal reflux disease (GERD), a condition that can potentially lead to esophageal cancer. GERD develops when stomach acid that digests food washes up into the esophagus.
After someone has had GERD for many years, it can advance to a condition called Barrett’s esophagus. Esophageal cells that have been bathed in acid for a long time begin to thicken as a defense mechanism to withstand the acid.
“The esophagus wants to protect itself, so the cells in the lining begin to change,” says Memorial Sloan Kettering thoracic surgeon Daniela Molena. “The normal tissue lining the esophagus begins resembling the lining of the stomach or intestine.”
Barrett’s esophagus is considered a precancerous condition and increases esophageal cancer risk. While only a small percentage of patients with Barrett’s esophagus end up developing esophageal cancer, it is important to monitor the condition in case it begins to progress.
Dr. Molena explains how to know if you have Barrett’s esophagus. In addition, she and MSK clinical dietitian-nutritionist Christina Stella describe what you can do to reduce the risk of it developing into cancer.
What are the symptoms of Barrett’s esophagus?
Barrett’s esophagus can develop after long-standing GERD, so a person with the condition may be used to experiencing heartburn or regurgitation soon after eating. But as GERD progresses to Barrett’s, sometimes these symptoms disappear, Dr. Molena says.
“Often when I ask patients if they have reflux or heartburn, they’ll say, ‘I used to have that when I was younger, but I don’t anymore,’” she says. “The pain often goes away when Barrett’s develops, which can be counterproductive because people seek less help for their symptoms.”
In addition, some people with Barrett’s never have any symptoms. “That’s why it can be hard to catch patients early and treat it before it becomes cancer,” Dr. Molena says.
How is Barrett’s esophagus diagnosed?
Doctors use a technique called endoscopy to diagnose and stage Barrett’s esophagus. In this test, a gastroenterologist puts a thin, flexible tube with a light and a camera at the tip, called an endoscope, down the throat to look at the lining of the esophagus.
“With the endoscope, you can see the lining in the lower part of the esophagus, which is where the changes usually can be seen,” Dr. Molena says. “The lining will have a different color. If it looks like Barrett’s, we’ll take a tissue sample for our pathologists to examine.”
The pathologist can determine how far along the Barrett’s esophagus is and whether it has become precancerous or cancerous and has the potential to spread to other areas of the body. At MSK, specialized gastrointestinal pathologists review the tissue and determine whether it has no dysplasia (precancerous cells), mild or high-grade dysplasia, or if it is already cancerous.
What can I do to prevent or reverse Barrett’s esophagus and minimize esophageal cancer risk?
The most important step is to reduce and minimize acid reflux. Effective ways to do this include:
- lose weight if you are overweight and obese
- don’t smoke
- limit alcohol consumption
- eat smaller meals, and wait a few hours before going to bed
- avoid late-night snacking
- sleep with your head slightly elevated (nighttime GERD is more damaging because the esophagus is also “sleeping” and does not promptly push acid down)
MSK Senior Clinical Dietitian-Nutritionist Christina Stella, who counsels many people at risk for esophageal cancer, says research has bolstered the strong link between obesity — especially around the belly — and Barrett’s esophagus and esophageal cancer. “Working with a dietitian and the primary care team on weight management is a very important lifestyle step that patients can take to reduce their risk,” she says.
Apart from this, changing your diet can make a big difference in preventing acid reflux. People often think reflux is tied to acidity in specific foods, such as citrus fruits or tomatoes, but that’s a misconception. Ms. Stella says it’s more important to follow a low-fat diet.
“This includes limiting both the bad fats you find in fried food, red meats, and butter, and the fats usually considered ‘good,’ like those found in avocados, olive oils, and some nuts,” she says. “The reason is that fat sits in the stomach for a long time and it can push up on the door into the esophagus, which lets out some of the acids causing that burning feeling.”
“Overall, focusing on more fruits and vegetables in the diet is the best approach to avoiding not just GERD and Barrett’s esophagus, but all forms of chronic disease,” she adds.
Apart from minimizing all types of fat, some people may want to try limiting coffee, mint, and chocolate, as they can be triggering for reflux, Ms. Stella says. Also, limiting alcohol may decrease gastric acidity, and alcohol consumption is a well-known risk factor for all cancers.
Sticking to any kind of diet is challenging for most people. Ms. Stella says sometimes interim steps work best — for example, reducing the quantities of certain foods rather than trying to eliminate them altogether. “If someone comes and tells me they can’t go without steak, my response would be, all right, can we do steak once a week instead of steak three times a week? That’s going to be a lot better for their health.”
What are the options for someone diagnosed with Barrett’s esophagus?
Barrett’s esophagus may not need treatment if it is diagnosed at an early or intermediate stage. Someone at low risk can be monitored with an endoscopy every three to five years to see if the cells change. “Barrett’s esophagus progresses in a very methodical way, which is why we like to see patients through the whole process,” Dr. Molena explains.
Usually, doctors can remove precancerous lesions using an endoscope before they become more serious. At MSK, they may destroy the lesions using endoscopic methods, including cryoablation (freezing), radiofrequency ablation (radio waves), or photodynamic therapy (destroying the abnormal cells using a light-sensitive drug and laser). They also can remove the lesions with a snare or dissecting knife if there is a concern for more advanced disease.
Because Barrett’s esophagus is related to GERD, it’s very important that patients with Barrett’s be treated for GERD with medications or procedures that alleviate the condition, even if they aren’t experiencing symptoms.
MSK has a dedicated program for monitoring and treating people with Barrett’s esophagus. It includes a database of information from hundreds of people who have been treated for the condition, which helps assess each new patient’s risk for esophageal cancer and a multidisciplinary team of gastroenterologists, surgeons, dietitians and nurses.