What is Barrett’s esophagus?
Barrett's esophagus results from an irritation in the lining of
the esophagus caused by chronic reflux of the contents from the stomach and
small intestine into the esophagus. The irritation causes the lining of the
esophagus to change and become similar to the lining of the intestine and
What are the symptoms of Barrett’s esophagus?
Barrett’s esophagus does not cause signs or symptoms, but
because there is a strong link between gastroesophageal reflux disease (GERD)
and Barrett’s esophagus, symptoms of Barrett’s esophagus may be similar to those
of GERD. The symptoms might include:
- A burning sensation under the chest
- Regurgitation (backing up) of stomach acids
- Difficulty swallowing (Note: This symptom requires immediate medical
What risk factors are associated with Barrett’s esophagus?
There are a number of risk factors for the development of
Barrett's esophagus, including:
- Symptoms of gastroesophageal reflux disease
- Increasing age
- Caucasian ethnicity
- Male gender
- Family history of Barrett’s esophagus
How is Barrett’s esophagus diagnosed?
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. A pathologist will examine the tissue
to make the diagnosis.
How is Barrett’s esophagus treated?
The treatment of Barrett's esophagus is similar to the treatment
of GERD. Treatment might begin with lifestyle changes, including:
- Not eating certain foods
- Not eating late in the evening
- Not smoking
Treatment is also likely to include the use of 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®),
pantoprazole (Protonix®), rabeprozole (Aciphex®),
esomeprazole (Nexium®), or dexlansoprazole (Kapidex®).
Omeprazole is now available as an over the counter preparation as well. These
medications are typically given before breakfast once a day or, on occasion,
before breakfast and dinner. H2 receptor antagonists are available as
prescriptions or as over-the-counter medications. 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
All patients with Barrett’s esophagus who are in reasonably good
health should undergo endoscopic surveillance at appropriate intervals. Patients
with no dysplasia on two endoscopies done one year apart should have subsequent
endoscopy done at 3 year intervals. Patients with low grade dysplasia should
first have their biopsies confirmed by an expert GI pathologist. Endoscopy
should be repeated within 6 months and then annually until 2 in a row are
negative prior to resuming surveillance at 3 year intervals.
Patients with high grade dysplasia should have their biopsies reviewed by an
expert GI pathologist and subsequently have endoscopy with meticulous biopsies
and endoscopic mucosal resection of any mucosal abnormalities within 3 months to
exclude unsuspected cancer.
What complications are associated with Barrett’s esophagus?
Barrett's esophagus is a premalignant condition that may lead to
the development of cancer of the esophagus in a small number of patients. The
risk of developing cancer is approximately 0.5% each year. This type of cancer
is called esophageal adenocarcinoma.
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
surveillance exams to detect cancer at an early and potentially curable stage.
How is Barrett’s esophagus with dysplasia or cancer treated?
Current treatments for Barrett’s esophagus with dysplasia or
cancer include photodynamic therapy, radiofrequency ablation, cryotherapy,
endoscopic mucosal resection, or surgical removal of almost all the esophagus.
Photodynamic therapy combines a light-sensitizing substance
(Photofrin®) with the use of a laser. The Barrett’s lining is
destroyed, along with the cancerous and precancerous tissue. This is rarely used
anymore due to the cost, side effects, and problematic long term results.
Radiofrequency ablation involves the use of radiofrequency
energy (an energy delivered via electrodes that is similar to microwave energy)
to destroy the Barrett’s lining and replace it with normal esophageal cells.
Results are promising for the treatment of low-grade dysplasia and high-grade
dysplasia. The use of radiofrequency ablation for nondysplastic Barrett’s
esophagus is controversial at present.
Cryotherapy involves freezing the lining of the esophagus with
subsequent replacement with normal esophageal cells. This technique is still
experimental and is currently under study.
Endoscopic mucosal resection involves the removing abnormal
areas of the Barrett’s lining by the use of an endoscopically placed snare
similar to what is used for colon polyps. Unlike other endoscopic techniques,
endoscopic mucosal resection allows for tissue confirmation by a pathologist.
Any mucosal abnormalities should be removed by endoscopic mucosal resection
prior to using other endoscopic or surgical techniques.
Surgical treatment of Barrett’s esophagus with cancer is used only when the
patient is strong enough to handle surgery and has high-grade dysplasia or
cancer. Often, people who have Barrett’s esophagus with cancer are older and
cannot tolerate surgery. If surgery is chosen as a treatment, virtually the
entire esophagus is removed and the stomach is pulled up into the neck.
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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. This document was last reviewed on: 8/25/2009…#14432