What Is Barrett's Esophagus?

The esophagus is the tube that connects your mouth to your stomach. Barrett’s esophagus is a condition where the tissue in your lower esophagus becomes damaged. It starts to resemble the tissue in your intestine. Doctors call this process intestinal metaplasia.

The average age of people diagnosed with Barrett’s esophagus is 55. Men tend to develop Barrett’s esophagus twice as often as women. Caucasian men develop this condition more often than men of other races.*  

Barrett’s Esophagus Dysplasia

If Barrett’s esophagus progresses, it is called dysplasia. Dysplasia can be either low grade or high grade depending on how bad it has gotten.

What Causes Barrett's Esophagus?

Experts don’t know the exact cause of Barrett’s esophagus. However, some factors can increase your chance of developing Barrett’s esophagus.

Having chronic GERD (gastroesophageal reflux disease) increases your chances of developing Barrett’s esophagus. GERD is a condition in which stomach contents reflux or flow back up into your esophagus. Between 10 and 15 percent of people with GERD may develop Barrett’s esophagus.*

Stomach acid that is refluxed and touches the lining of your esophagus can cause heartburn. It can also damage the cells in your esophagus.

Other factors that increase your risk of getting Barrett’s esophagus are obesity (high levels of belly fat) and smoking.

Symptoms of Barrett's Esophagus

While Barrett’s esophagus itself doesn’t cause symptoms, many people with Barrett’s esophagus have gastroesophageal reflux disease (GERD). GERD causes symptoms of heartburn and regurgitation.

These symptoms include a burning sensation in the chest and vomit in the back of your throat (acid regurgitation). If you get heartburn at least twice a week, you should consider seeing a doctor.

Other symptoms to watch for include:

  • heartburn that gets worse or wakes you from sleep.
  • painful or difficult swallowing.
  • Feeling like food is stuck in your esophagus.
  • constant sore throat, sour taste in your mouth, or bad breath.
  • weight loss.
  • blood in your stool. 

Diagnosing Barrett's Esophagus

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Doctors may also find you have Barrett’s esophagus when they are testing you for the cause of gastroesophageal reflux disease (GERD) symptoms.

Medical History

First your doctor will ask you for your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Upper GI Endoscopy and Biopsy

Next, your doctor will do an upper GI endoscopy. During the endoscopy, a gastroenterologist uses an endoscope to see inside your upper GI tract. Generally you are under light sedation while you have the endoscopy.

The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. The procedure can show whether there have been changes in the lining of your esophagus.

To perform a biopsy, your doctor will take a small piece of tissue from the lining of your esophagus with the endoscope. You won’t feel the biopsy. Then a pathologist examines the tissue in a lab to determine whether Barrett’s esophagus cells are present.

Barrett's Esophagus Treatment

Your doctor will talk with you about the best treatment options. They will make recommendations based on your overall health, whether you have dysplasia, and how severe your dysplasia is.

Treatment options include:

  • medicines for GERD,
  • monitoring by endoscopy,
  • endoscopic ablation,
  • endoscopic mucosal resection, and 
  • surgery.

Medicines

If you have Barrett’s esophagus and gastroesophageal reflux disease (GERD), your doctor will treat you with medication that suppresses stomach acids. They are called proton pump inhibitors (PPIs). These medicines can prevent additional damage to your esophagus. In some cases they can also heal the damage. 

Your doctor may also consider anti-reflux surgery if you have GERD symptoms and don’t respond to medicines.

Monitoring by Endoscopy

Your doctor may recommend that you regularly get an upper gastrointestinal endoscopy with a biopsy. This is to watch for signs of dysplasia or cancer development. They may recommend endoscopies more frequently if you have high-grade dysplasia rather than low-grade or no dysplasia. 

Endoscopic Ablation

Endoscopic ablation uses different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should begin making normal esophageal cells. You should also have a much lower risk of developing cancer.

A doctor, usually a gastroenterologist or surgeon, performs these procedures at certain hospitals and outpatient centers. You will receive an anesthesia for your abdominal area and a sedative. The most common procedure is radiofrequency ablation. 

Radiofrequency Ablation

Radiofrequency ablation uses radio waves to kill cells that may be cancerous. Electrodes on a balloon or a touch pad create heat to destroy the Barrett’s tissue. The heat also destroys precancerous and cancerous cells. Doctors perform this ablation by an upper endoscopy.

Endoscopic Mucosal Resection

In endoscopic mucosal resection, your doctor:

  • lifts the Barrett’s tissue,
  • injects a solution underneath or applies suction to the tissue, and
  • cuts the tissue off.

The doctor then removes the tissue with an endoscope.

Gastroenterologists perform this procedure at certain hospitals and outpatient centers. You will receive sedation for the procedure to help you relax and stay comfortable throughout.

Complications can include pain, bleeding, or a slit in your esophagus. The complications of bleeding and perforation of the esophagus are very rare.

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Barrett's Esophagus Diet Plan

Researchers have not found that diet and nutrition play an important role in causing or preventing Barrett’s esophagus. (Though eating a healthy diet can help you keep a healthy weight.)*

If you have gastroesophageal reflux disease (GERD), you can reduce your symptoms by changing your diet. Dietary changes that can help reduce your symptoms include the following:

  • decreasing fatty foods
  • eating small, frequent meals instead of three large meals
  • avoiding meals before bedtime

The following items may make your GERD symptoms worse. You should avoid eating or drinking them:

  • chocolate
  • coffee
  • peppermint
  • greasy or spicy foods
  • tomatoes and tomato products
  • alcoholic drinks

Cancer & Barrett's Esophagus

People with Barrett’s esophagus are more likely to develop a rare type of cancer. This cancer is called esophageal adenocarcinoma. Before this cancer develops, precancerous cells called the Barrett’s tissue occur.

You may have Barrett’s esophagus for many years before cancer develops. For this reason, your doctor may recommend regular endoscopies and biopsies to monitor your condition.

Should You Get Screened for Barrett's Esophagus?

Your doctor may recommend getting screened for Barrett’s esophagus if you have chronic symptoms of GERD. Chronic GERD is heartburn and acid reflux that last more than five years. You also feel these symptoms at least weekly.

Your doctor may also recommend you get screened if you are:

  • age 50 and older,
  • Caucasian,
  • have high levels of belly fat,
  • a smoker or have smoked in the past, and/or
  • have a family history of Barrett’s esophagus or esophageal adenocarcinoma.

When Should You See a Doctor?

If you have symptoms of heartburn that happen at least twice a week, you should consider seeing a doctor. These include feeling:

  • pain or difficulty when you swallow.
  • That food is stuck in your esophagus.
  • constant sore throat, sour taste in your mouth, or bad breath.
  • blood in your stool. 

Referral Information

You will need a referral from your primary care provider to see a GI specialist. Feel free to contact us with any questions about how to make an appointment.

*National Institute of Diabetes & Digestive & Kidney Diseases https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/symptoms-causes

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