Barrett’s Esophagus

Written by Carmella Wint and Elizabeth Boskey, PhD | Published on July 25, 2012
Medically Reviewed by George Krucik, MD

Overview

The esophagus is a muscular tube that transports food from the mouth to the stomach.

Barrett’s esophagus is a condition that occurs when cells in the lining of the esophagus are damaged, usually because of exposure to acid from the stomach. This can happen as a complication of many years of suffering from gastroesophageal reflux (GER, commonly known as heartburn).

It is estimated by the National Digestive Diseases Information Clearinghouse that 1 percent of adults in the United States have Barrett’s esophagus. The abnormal cells caused by Barrett’s esophagus can become cancerous in some cases, though this is rare.

Causes and Risk Factors

The exact cause of Barrett’s esophagus is not yet known, but the condition is most commonly seen in those with some sort of reflux like GER. GER occurs when the muscles at the bottom of the esophagus that are supposed to close and prevent food and acid from coming back up into the esophagus do not work properly. It is believed that cells of the esophagus can become abnormal when trying to heal from repeated exposure to the stomach acid. Though GER is often seen in those with Barrett’s esophagus, it is entirely possible for you to have Barrett’s esophagus and not have any sort of reflux or heartburn.

If you have heartburn or gastroesophageal reflux disease (GERD) for longer than 10 years, you have an increased risk of developing Barrett’s esophagus because of the damage that stomach acid causes to the esophagus. The condition is more common in men than women, and white people are at higher risk of developing Barrett’s esophagus than others. Though Barrett’s esophagus can occur at any age, it is more common in those over the age of 50.

Recognizing the Symptoms of Barrett’s Esophagus

Barrett’s esophagus itself does not have any symptoms and most of the symptoms that you may experience are related to the acid reflux that sometimes occurs. Some symptoms of acid reflux are pain in the chest and abdomen as well as a dry cough. You may also experience difficulty with swallowing and frequent heartburn. If you vomit blood, you should seek immediate medical attention. Vomited blood may be red or look like coffee grounds, and if you experience bloody or tar-like stools, consult with your physician as soon as you can.

Diagnosing and Classifying Barrett’s Esophagus

Barrett’s esophagus is diagnosed with the use of endoscopy—a procedure the employs the use of a tube with a small camera and light on it that allow your doctor to see the inside of your esophagus. Your doctor will be checking to make sure that your esophagus looks pink and shiny. If you have Barrett’s esophagus, however, your physician may find that your esophagus looks red and velvety.

Your doctor may also take a tissue sample using the endoscope, which will allow him or her to discern what changes are going on within the esophagus with the aid of a microscope. Your doctor will be looking for one of the following degrees of change:

  • no abnormalities—this is considered to be a case with no “dysplasia”
  • small amount of abnormalities—low-grade dysplasia
  • large amount of abnormalities and cells that may become cancerous—high-grade dysplasia

Treatment Options for Barrett’s Esophagus

Treatment for Barrett’s esophagus depends on what level of dysplasia your doctor determines you have.

No or Low-Grade Dysplasia

Those with no or low-grade dysplasia are usually treated by treating the GER or GERD that is associated with Barrett’s esophagus. Medications are often prescribed to help with the symptoms that GER and GERD cause. In some cases, surgery is performed on the sphincter located at the bottom of the esophagus to help keep acid from backing up into the esophagus. While medication and surgery will help with GER symptoms and continued damage, it is not a cure for Barrett’s esophagus. If you have low or no dysplasia, your doctor will likely schedule you for yearly endoscopy procedures to make sure that your condition has not advanced.

High Grade Displasia

If you have high-grade dysplasia, your doctor may want to employ the use of more invasive procedures to remove the affected area of your esophagus. Your doctor may remove damaged areas of the esophagus through the use of endoscopy. In some cases, removal of an entire portion of the esophagus may be performed, though it is typically not recommended due to the complications that may arise. An experienced surgeon would reduce the risk of complications, but you still may experience bleeding or narrowing of the esophagus after surgery.

Radiofrequency ablation is a method of using heat to destroy damaged esophageal tissue through the use of bursts of energy. A similar method called cryotherapy, which involves the use of a cold liquid or gas to freeze the abnormal cells, is also sometimes used. After the cells thaw out, they are frozen again, and this process is repeated until the cells inevitably die from the damage caused by the repeated freezing and thawing. Both of these methods of treatment can result in chest pain and narrowing of the esophagus.

With treatment methods other than the removal of the esophagus, Barrett’s esophagus can return. Doctors often recommend regular endoscopies.

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