What is Barrett’s esophagus and how is it treated?
Barrett's esophagus is an irritation in the lining of the esophagus caused by chronic reflux of the contents from the stomach and small intestine into the esophagus. There are a number of risk factors for the development of Barrett's esophagus, including:
- Early onset of reflux symptoms
- Long duration of reflux symptoms
- Reflux symptoms at night
Patients at greatest risk of developing Barrett's are Caucasian males over age 50 who have a history of chronic heartburn.
The symptoms of Barrett's esophagus are similar to the symptoms of gastroesophageal reflux disease (GERD). These include a burning sensation under the chest and acid regurgitation. These symptoms generally decrease with medications that reduce acid in the stomach.
Some people with Barrett’s may also have difficulty swallowing. This symptom requires immediate medical attention.
The only way to confirm the diagnosis of Barrett's esophagus is with a test called an upper endoscopy. This involves inserting a small lighted tube (endoscope) through the throat and into the esophagus to look for a change in the lining of the esophagus. While the appearance of the esophagus may suggest Barrett's esophagus, the diagnosis can only be confirmed with small samples of tissue (biopsies) obtained through the endoscope.
The treatment of Barrett's esophagus is similar to the treatment of GERD. This includes lifestyle changes, such as avoiding certain foods, not eating late in the evening, stopping smoking, and wearing loose-fitting clothing, along with using medications that will decrease acid production by the stomach.
Patients with Barrett's esophagus typically need prescription medications to reduce acid, such as omeprazole (Prilosec)
, lansoprazole (Prevacid), pantoprafile (Protonix), rabeprazole (Aciphex), or esomeprazole (Nexium). These medications are typically taken before breakfast once a day or, on occasion, before breakfast and dinner. Over-the-counter medications known as H2 receptor antagonists (Tagamet, Zantac, Axid, and Pepcid) are generally not as effective in decreasing the acid damage to the esophagus that causes Barrett's esophagus, but may relieve symptoms for some patients.
Barrett's esophagus is a premalignant condition that may lead to the development of cancer of the esophagus in some patients. The risk of developing cancer is approximately 1% each year.
Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia. Dysplasia can only be detected by endoscopic biopsies. Patients with Barrett's esophagus should have regular screening exams to detect cancer at an early and potentially curable stage.
Studies are in progress to develop a more effective treatment for Barrett's esophagus. One treatment, known as ablation therapy, damages the lining of the esophagus with heat or laser light. This causes normal cells to develop because of a decrease in acid production. This type of therapy holds great promise for the future, although it is still in the testing phase. Other new treatments are also under development.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit
www.clevelandclinic.org/health. This document was last reviewed on: 11/15/2005
