What is Barrett esophagus?

Barrett esophagus occurs when the normal cells that line your food pipe (esophagus) turn into abnormal cells not usually found in your esophagus. The abnormal cells take over because the lining of the esophagus has been damaged. The abnormal cells are called specialized columnar cells or intestinal metaplasia.

It's very rare that someone with this disease will get cancer of the esophagus. But having Barrett esophagus raises your risk of having esophageal cancer.

What causes Barrett esophagus?

You may get Barrett esophagus if you have frequent heartburn that lasts for many years. Heartburn is also called GERD (gastroesophageal reflux disease) or acid reflux disease. You may also get it if you have swelling of the esophagus (esophagitis). These health problems harm the lining of your esophagus. This can cause the abnormal cells to take over.

If you have long-term (chronic) heartburn, you are at risk for Barrett esophagus. Talk with your health care provider.

Who is at risk for Barrett esophagus?

You are at greater risk of getting Barrett esophagus if you are:

• Age 50 or older.

• Male. Men are 3 to 4 times more likely to have Barrett esophagus than are women.

• White. Barrett esophagus is most common in white populations. It's less common in Hispanic populations, and it's uncommon in Asian and Black populations.

• Obese. Barrett esophagus is especially associated with the central type of obesity in which fat accumulates mostly in the abdomen.

• A tobacco smoker.

• Related to someone with Barrett esophagus. If your parent, sibling, or child has or had Barrett esophagus or adenocarcinoma of the esophagus, then your risk of having Barrett esophagus is higher.

Barrett esophagus is not common in children.

What are the symptoms of Barrett esophagus?

Each person’s symptoms may vary. Some people with Barrett esophagus have no symptoms. Others have symptoms caused by GERD. These include:

• Heartburn.

• Regurgitation.

• Trouble swallowing.

In some cases, you may not have any symptoms. Or the signs of Barrett esophagus may look like other health problems. Always see your health care provider for a diagnosis.

How is Barrett esophagus diagnosed?

Your health care provider will give you a physical exam. They will also do a test called an endoscopy. During the test, your provider will put a long, thin tube (endoscope) in your mouth and down into your esophagus.

The endoscope has a small camera and tools. Your provider uses the camera to see the lining of your esophagus. They will use the tools to remove a small tissue sample (a biopsy). This tissue sample will be sent to a lab. It will be examined to see if your normal cells have been taken over by abnormal cells.

If you are having trouble swallowing, your provider may also do an upper GI (gastrointestinal) barium study. This test may show if you have a narrowing (stricture) of the esophagus. This narrowing happens when the damaged lining of the esophagus gets thick and hard.

How is Barrett esophagus treated?

Treatment will depend on the cause and your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for Barrett esophagus centers on acid blockers. These will also treat GERD symptoms. Barrett esophagus is usually long-lasting (permanent). But it may go away in some people.

Your health care provider will make a care plan for you. The plan will try to stop any more damage by keeping acid reflux out of your esophagus. Your care plan may include:

• Behavior and diet changes. Avoid certain foods and behaviors that increase the risk of reflux.

• Medicine. You may be given medicine to reduce how much acid is made in your stomach. A type of medicine called a proton pump inhibitor is often recommended.

• Endoscopic ablative therapies. These therapies use different techniques to destroy the dysplasia in your esophagus. After the therapies, your body should start making normal esophageal cells.

  • Photodynamic therapy. This uses a light-activated chemical called porfimer (Photofrin), an endoscope, and a laser to kill precancerous cells in your esophagus.

  • Radiofrequency ablation. This treatment uses radio waves to kill precancerous and cancerous cells in the Barrett tissue. This treatment is commonly done for certain advanced types of Barrett esophagus. It is done during an upper endoscopy.

• Endoscopic mucosal resection. This treatment removes any nodular (bumpy) Barrett esophagus changes in your esophagus. It is done during an upper endoscopy.

• Surgery. You may need a type of surgery called fundoplication. This surgery is not done for Barrett esophagus. But if your GERD symptoms aren't controlled with medicine, it may be considered.

If you have developed esophageal cancer, other treatments will be offered.

Can Barrett esophagus be prevented?

You can help lower your risk of getting Barrett esophagus by:

• Eating lots of fruits and vegetables.

• Losing weight and staying at a healthy weight.

• Quitting smoking.

• Avoiding foods that trigger heartburn.

Living with Barrett esophagus

If you have Barrett esophagus, your health care provider will give you follow-up instructions. You may not need surgery or another treatment right away. But you should have GI studies done from time to time. These will help to see if your case has gotten worse. They will also determine if you need surgery or another treatment. If medicines are advised, take them as prescribed. Stay at a healthy weight, and follow other lifestyle guidelines from your provider.

When should I call my doctor?

Contact your health care provider right away if any of your early symptoms come back or get worse after you’ve had medicine, surgery, or other treatments. Call your provider if you:

• Continue vomiting.

• Vomit blood. (Call 911 if you are vomiting blood.)

• Have trouble swallowing.

• Have side effects from your medicines or have questions about how to take them.

Key points about Barrett esophagus

• Barrett esophagus occurs when the normal cells that line your food pipe (esophagus) turn into abnormal cells not usually found in your esophagus.

• This happens because the lining of your esophagus has been damaged.

• You may get this if you have long-term GERD (gastroesophageal reflux disease).

• You are at greater risk if you are white, male, obese, and age 50 or older.

• Having Barrett esophagus may raise your risk of getting esophageal cancer.

• There is no cure for Barrett esophagus. But medicines to reduce stomach acid and a surgery called fundoplication may be used to treat the disease. Because Barrett esophagus tends to recur (come back), you will need continued monitoring.

• Your care plan will try to stop any more damage by keeping acid reflux out of your esophagus.

Next steps

Here are some tips to help you get the most from a visit to your health care provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is advised and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.