Barrett's esophagus

By Mayo Clinic Staff

Overview

Barrett's esophagus is a condition in which the lining of the tube between the mouth and stomach changes due to repeated backflow of stomach acid. This process is known as acid reflux.

The esophagus (uh-SOF-uh-gus) has a valve at its lower end that typically helps keep stomach contents from flowing upward. When this valve weakens or does not function as intended, stomach contents, including acid, can move back into the esophagus.

Unlike the stomach, the esophagus is not designed to tolerate repeated exposure to acid. Over time, this ongoing irritation can damage the esophageal lining and prompt it to change into a different type of tissue. The typically smooth, pink lining becomes thick and red.

Barrett's esophagus increases the risk of developing a rare form of cancer called esophageal adenocarcinoma. Because of this increased risk, people with Barrett's esophagus are often monitored with regular screening exams.

Treatments for Barrett's esophagus include medicines to reduce stomach acids, changes in diet and lifestyle, and procedures that remove or treat the altered tissue in the esophagus.

Symptoms

Barrett's esophagus doesn't itself have symptoms. But people with Barrett's esophagus may experience the symptoms of the condition that likely triggers it.

Gastroesophageal reflux, also called acid reflux, is the backflow of acid and other contents of the stomach into the esophagus. When symptoms are serious and long-lasting, the condition is called gastroesophageal reflux disease (GERD). GERD may trigger changes to the lining of the esophagus seen in Barrett's esophagus.

Symptoms of GERD include frequent episodes of:

• A burning sensation in your chest, called heartburn.
• Bitter or sour tasting fluid that travels up the esophagus to the mouth.
• Pain in the chest or below the chest.
• Trouble swallowing.

Nearly half of people diagnosed with Barrett's esophagus report that they haven't had heartburn or other symptoms of GERD.

When to see a doctor

If you often have episodes of acid reflux or a diagnosis of GERD, talk to your healthcare professional about screening for Barrett's esophagus.

Seek immediate help if you experience:

• Chest pain, which may be a symptom of a heart attack.
• Difficulty swallowing.
• Weight loss that isn't intended.
• Vomit that contains blood, looks yellow or green, or looks like coffee grounds.
• Black, tarry or bloody stools.

Causes

The cause of Barrett's esophagus is related to the backflow of stomach contents into the esophagus. Between the esophagus and the stomach is a valve called the lower esophageal sphincter. Typically, this valve opens to allow food and drink to move from the esophagus to the stomach. The valve then closes to keep acids and other things that help digest food in the stomach.

The valve may weaken or fail to work properly. When this happens, the stomach contents can flow in the wrong direction into the esophagus. For reasons that are not clear, the cells of the tissue lining the esophagus change. The result is a tissue not typically found in the esophagus, and it looks more like the tissue lining the small intestine.

Risk factors

The risk of Barrett's esophagus is linked to the following factors:

• Family history. A family history of Barrett's esophagus increases the risk of the condition.
• Sex. Men are far more likely to develop Barrett's esophagus than women.
• Race. People who are white have a greater risk of Barrett's esophagus.
• Age. Barrett's esophagus is more common in adults over 50.
• GERD. GERD — especially when it isn't treated, requires long-term treatment or doesn't get better with treatment — increases the risk of Barrett's esophagus.
• Smoking. Current or past smoking is linked to a higher risk.
• Weight. Being overweight, especially having extra weight around the belly, is a risk factor.

Complications

People with Barrett's esophagus have an increased risk of developing a rare type of esophageal cancer called esophageal adenocarcinoma. Screening for cancer is a regular part of Barrett's esophagus care.

Diagnosis

An exam will include a general physical. Your healthcare professional also will typically ask about your symptoms, diet, lifestyle habits and medical history.

A procedure called endoscopy is used to determine if you have Barrett's esophagus. An endoscope is a flexible tube with a light and camera that transmits images to a screen. A health professional passes the tube down your throat and into the esophagus. A probable diagnosis of Barrett's esophagus can often be suggested based on the appearance of the esophageal lining during the exam. A lab test is used to confirm it.

An endoscope also has a tool to remove small tissue samples, called biopsies, that are examined in a lab. A health professional who specializes in examining tissues, called a pathologist, can confirm that cells from a biopsy of the esophagus have undergone changes seen in Barrett's esophagus.

Determining cancer risk

Pathologists also will look for irregular cells that could lead to cancer. The presence of these precancerous cells is called dysplasia. A diagnosis of dysplasia requires lab exams by two pathologists, including one who specializes in diseases of the digestive system.

The findings are classified as one of the following:

• Indefinite for dysplasia means that it's not certain if any changes in cells are precancerous.
• Low-grade dysplasia is the presence of some precancerous cells that suggest an increased risk of developing cancer.
• High-grade dysplasia is the presence of many precancerous cells and a greater risk of cancer.

Screening for Barrett's esophagus

The American College of Gastroenterology (ACG) recommends screening for Barrett's esophagus in people who have long-term GERD and three or more risk factors for Barrett's esophagus:

• Male.
• Over age 50.
• White racial identity.
• Tobacco smoking.
• Obesity.
• Parents or siblings with Barrett's esophagus or esophageal cancer.

Screening for Barrett's esophagus is usually done with endoscopy.

Another screening test involves drinking water to swallow a capsule attached to a string. When the capsule dissolves, a tiny sponge is released. When the sponge is pulled back up with the string, it collects tiny samples that can be studied in a lab.

Treatment

Treating GERD

Most people with Barrett's esophagus are prescribed medicines called proton pump inhibitors (PPIs). The medicines make the contents of the stomach less acidic. Stomach contents will still flow back into the esophagus, but there may be less damage to the lining of the esophagus. This treatment may allow tissues to heal.

A surgery called Nissen fundoplication may be recommended if there's no improvement in symptoms or tissue health after taking PPIs for a long period and after making changes in diet and lifestyle habits. In this procedure, the top portion of the stomach is wrapped around the lower part of the esophagus. This reinforces the valve between the esophagus and stomach and helps prevent acid reflux.

Treatments to reduce cancer risk

Other interventions are meant to screen for and reduce the risk of cancer. The management plan varies depending on cancer risk.

Indefinite for dysplasia

Your healthcare professional will likely recommend endoscopy with a biopsy within one year after a diagnosis of Barrett's esophagus. If there is no sign of dysplasia, the test is repeated in 3 to 5 years.

Low-grade dysplasia

Low-grade dysplasia is an early stage of precancerous changes in cells. Your healthcare professional may recommend a regular endoscopy to monitor your condition. The test may be repeated as often as every six months.

Other options are procedures to remove or destroy irregular tissues from the lining of the esophagus. Procedures may include the following.

• Endoscopic resection uses an endoscopic tool to cut out irregular tissues that are visible with the endoscope. These tissues are examined in a lab for precancerous or cancerous cells.
• Radiofrequency ablation uses an endoscope to apply heat to destroy irregular esophagus tissue. This procedure is often used after a resection to ensure the destruction of precancerous cells.
• Cryotherapy ablation also uses an endoscope to apply a cold liquid or gas to destroy irregular tissues, usually after a resection.

High-grade dysplasia

High-grade dysplasia is the presence of many precancerous cells and is linked to a greater risk of cancer. Your healthcare professional may recommend endoscopic resection, radiofrequency ablation or cryoablation to remove irregular tissues.

In rare cases, a section of the esophagus may be removed. This procedure is called an esophagectomy. Tissues from elsewhere in the body are used to replace the removed section.

Self-care

Lifestyle changes can ease symptoms of GERD. Your healthcare professional will likely recommend the following:

• Maintaining a healthy weight.
• Eliminating foods and drinks that trigger your heartburn, such as chocolate, coffee, alcohol and mint.
• Stopping smoking.
• Raising the head of your bed. Place wooden blocks under your bed to elevate your head.

Ask your healthcare professional about services and programs to help you reach these treatment goals.

Preparing for your appointment

Barrett's esophagus is most often diagnosed in people with GERD who are being examined for GERD complications. If your healthcare professional discovers Barrett's esophagus on an endoscopy exam, you may be referred to a doctor who treats digestive diseases, called a gastroenterologist.

What you can do

• Be aware of any pre-appointment restrictions, such as not eating solid food on the day before your appointment.
• Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
• Make a list of all your medicines, vitamins and supplements; the doses; and the reason for taking each one.
• Write down your key medical information, including other conditions.
• Ask a relative or friend to accompany you to help you remember what your healthcare professional says.
• Write down questions to ask your healthcare professional.

Questions to ask your doctor

• Do my lab reports show precancerous changes? If so, what is the grade of my dysplasia?
• How much of my esophagus is affected?
• How often should I be screened for changes to my esophagus?
• Do I have dysplasia? Was the diagnosis confirmed by an expert in gastrointestinal pathology?
• What's my risk of esophageal cancer?
• What are the treatment options?
• Do I need to make diet or other lifestyle changes?
• I have other health conditions. How can I best manage these conditions together?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be ready to answer the following questions:

• When did you first begin experiencing symptoms?
• Are your symptoms continuous or occasional?
• What, if anything, seems to worsen your symptoms? Does anything make your symptoms better?
• Do you experience heartburn or other symptoms of acid reflux?
• Do you take any medicines for acid reflux or indigestion?
• Do you have difficulty swallowing?
• Have you lost weight?