Barrett's Esophagus

Dr. Malloy discusses a successful treatment for Barrett’s Esophagus that helped Jim Manlick.

If your lower esophagus is exposed to stomach acid for a long time, you can develop a condition called Barrett's esophagus. The acid changes the cells in your esophagus.

You're more likely to get Barrett's esophagus if you have had heartburn or gastroesophageal reflux (GERD) for a long time.

Barrett's esophagus increases your risk of esophageal cancer. This increased risk is not high. If you have Barrett's esophagus, your doctor checks over time to make sure the cells in your esophagus don't show signs of precancer (dysplasia) and treats you if these symptoms develop.

Doctors don't know exactly what causes all cases of Barrett's esophagus. Most people who have Barrett's esophagus have had GERD for a long time. You can get Barrett's esophagus even if you haven't had GERD.

You Are at Risk for Barrett's Esophagus if You:

  • Have had gastroesophageal reflux (GERD) for a long time (more than 10 years); 5 to 10 percent of people with GERD get Barrett's esophagus
  • Have had heartburn for a long time (more than 10 years)
  • Are male (twice as common in men)
  • Are older (average age at diagnosis is 55)
  • Are Caucasian (white)
  • Are obese

Symptoms

You can have Barrett's esophagus and not have any symptoms. Usually symptoms are related to gastroesophageal reflux (GERD) and include:

  • Heartburn
  • Chest pain
  • Upper abdominal (stomach) pain
  • Trouble swallowing food
  • A dry cough

Chest pain and trouble swallowing can be signs of something more serious. Get immediate medical care if you have those symptoms.

Diagnosis

The main test to check for Barrett's esophagus is EGD (esophagogastroduodenoscopy). This is also called upper GI endoscopy.

In this test, your doctor inserts an endoscope (lighted tube equipped with a tiny camera) in your mouth and down your throat. Your doctor looks for changes to the tissue in your esophagus.

Your doctor may remove tissue samples (biopsy) from your esophagus during this procedure. This is done by inserting tools through the endoscope to get some cells. They are checked in a lab to find out if there is a problem like dysplasia and how severe it is – no dysplasia, low-grade dysplasia or high-grade dysplasia.

Treatment

Treatment for Barrett's esophagus depends on whether you have signs of dysplasia (precancer).

No Dysplasia

You may not need treatment if you have Barrett's esophagus but do not have signs of dysplasia. Your doctor may recommend medication to reduce the amount of acid your body produces. Even if you don't have treatment, your doctor will continue to check your esophagus over time using endoscopy. Your doctor will talk to you about how often you should be checked.

Low-grade Dysplasia

If you have low-grade dysplasia, you might have endoscopy more often. Your doctor might recommend treating any GERD symptoms you have. Treatment includes medications and, sometimes, surgery to tighten the muscle that controls the flow of stomach acid. However, treating GERD doesn't mean your Barrett's esophagus goes away.

Your doctor will continue to check your esophagus over time using endoscopy. Your doctor will talk to you about how often you should be checked.

High-grade Dysplasia

If you have high-grade dysplasia, you are at risk for esophageal cancer. You need regular checks with endoscopy and more aggressive treatment of GERD.

Radiofrequency ablation is a procedure your doctor might suggest to treat high-grade dysplasia. It uses heat to take out the abnormal tissue. Your doctor puts an endoscope equipped with electrodes in your throat. The electrodes put out energy (radiofrequency ablation) that destroys the abnormal tissue.

As with any procedure, the treatment has risks for complications. Your doctor will talk to you about them and help you make the best decision for your condition. Except for removal of the esophagus, none of the treatments guarantee that Barrett's esophagus won't return.

How to Prevent Barrett's Esophagus

Some, but not all, cases of Barrett's esophagus are related to long-term gastroesophageal reflux (GERD) and heartburn. If you have either of these conditions, talk to your doctor about ways to treat them to reduce your risk for developing Barrett's esophagus.

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