Barrett's Esophagus

Barrett's Esophagus Treatment Manhattan | New York City | NYC

This information is intended only to provide general guidance. It does not provide definitive medical advice. It is important that you consult your doctor about your specific condition.

What is Barrett's esophagus?

In Barrett's esophagus, the inner lining of the esophagus changes and becomes more like the lining of the small intestine ("specialized intestinal metaplasia") than the esophagus ("squamous mucosa"). This occurs in the lower part of the esophagus, just above the stomach. The esophagus is the hollow tube that carries food from the back of the mouth down through the chest into the stomach.

What causes Barrett's esophagus and who is at risk?

Barrett's esophagus is a result of chronic inflammation due to gastroesophageal reflux disease (GERD). It is more common in people who have had gastroesophageal reflux disease symptoms for years or who developed gastroesophageal reflux disease at a young age. Even mild gastroesophageal reflux, if it is prolonged, can increase the risk of Barrett's esophagus. About 10% of gastroesophageal reflux disease(GERD) patients eventually develop Barrett's esophagus. Barrett's esophagus is also more common in men (twice as common as women), people over the age of 50, obese people, and Caucasians. Although Barrett's esophagus can occur in people who have not had reflux symptoms, it is infrequent enough that screening for Barrett's esophagus is not necessary in these people.

What are the consequences of having Barrett's esophagus?

The significance of Barrett's esophagus is that there is an increased risk of esophageal cancer. About one in 200 Barrett's esophagus patients will develop esophageal cancer each year. Thus, for example, for a 50-year-old patient who has a thirty-year life expectancy, the lifetime risk of esophageal cancer is 15%, or 1 in 7. Although this is a much higher risk of cancer than in the general population, most patients with Barrett's esophagus will never develop esophageal cancer. In some patients, the Barrett's esophagus tissue will go on to develop a precancerous changes called dysplasia. Tissue with dysplasia is much more likely to develop into adenocarcinoma, a type of esophageal cancer.

How is Barrett's esophagus detected?

The only current method to identify those people who have Barrett's esophagus is upper GI endoscopy (EGD), in which a thin tube containing a light and a camera is passed through the mouth to look inside the esophagus. When there is Barrett’s esophagus, areas of the esophagus lining appear salmon-colored, instead of the usual whitish color of the normal esophagus lining. If the appearance suggests Barrett's esophagus, biopsies (small pieces of tissue that are pinched off the inner lining of the esophagus) are taken and examined under a microscope in the pathology laboratory. The purpose of the biopsies is to confirm the diagnosis of Barrett's esophagus and to check for dysplasia.

What should I do if I have Barrett's esophagus?

Patients with Barrett's esophagus require a periodic checkup upper GI endoscopy (EGD) to search for dysplasia, the precancerous change. This will reduce the risk of developing esophageal cancer. An upper GI endoscopy (EGD) should be done 1-2 years after your first diagnosis and then every 2-3 years after that. Multiple biopsies of the abnormal (Barrett's) lining are taken and examined under a microscope in a pathology laboratory. There are four possible results:

1. No dysplasia (the cells of the esophagus are organized in an orderly pattern).

2. Low-grade dysplasia (the cells are mildly abnormal, but most of the cells are not involved, and the growth pattern of the cells is still normal). This requires a repeat upper GI endoscopy (EGD) in 6 months. If dysplasia is still present, treatment to remove the Barrett's esophagus should be considered (see below).

3. High-grade dysplasia (abnormal changes are seen in many of the cells and there is an abnormal growth pattern of the cells). This is the stage that occurs before esophageal cancer. Patients with high-grade dysplasia are at significant risk for esophageal cancer. If this is found, you will need either a repeat upper GI endoscopy (EGD) in 3 months or treatment to remove the Barrett's esophagus (see below).

4. Indefinite (or indeterminate) for dysplasia. This means that the tissue may be precancerous, but there is enough inflammation present make it hard to interpret the biopsies under the microscope. Usually an upper GI endoscopy (EGD) is repeated in 6 months with extra medications to suppress acid production and treat gastroesophageal reflux disease for one month before the repeat endoscopy. Once the inflammation is decreased, it is easier for the pathologist to analyze the slide and decide if dysplasia is really present.

If dysplasia is found, a second pathologist who specializes in esophageal disease should confirm the diagnosis. If dysplasia is confirmed, the options are more frequent endoscopies, special endoscopic procedures to destroy or remove the Barrett's tissue, or esophageal surgery.

Smoking tobacco increases the dysplasia and cancer risk if you have Barrett's esophagus, so you should stop smoking. Smoking also greatly increases the risk of another type of esophageal cancer, squamous cell carcinoma, which occurs in patients who do not have Barrett's esophagus.

There is some evidence that the permanent use of medications for gastroesophageal reflux disease (GERD) decreases the risk of dysplasia and cancer in Barrett's esophagus patients. Therefore, if you are not already on such medications for your gastroesophageal reflux disease, your doctor may prescribe them because of the Barrett's esophagus.

If you develop new symptoms such as difficulty swallowing, chest pain, worsening gastroesophageal reflux (GERD) symptoms, weight loss, or black stools, you should see your doctor as soon as possible.

How can the abnormal Barrett's lining be eliminated?

Elimination of the Barrett's esophagus is only necessary if dysplasia is found to be present and is confirmed by a specialized pathologist. Endoscopic treatments to destroy the Barrett's tissue include radiofrequency ablation (Barrx), argon plasma coagulation, multipolar coagulation, cryotherapy, photodynamic therapy using light and special injected medications, and endoscopic mucosal resection. Major surgery (removal of the esophagus) can also be done.

Barrett's esophagus cannot be eliminated by any medications or even anti-reflux surgery.