Barrett esophagus
Barrett's esophagus; GERD - Barrett; Reflux - BarrettBarrett esophagus (BE) is a disorder in which the lining of the esophagus is damaged by stomach acid leading to changes in the cells of the lining. The esophagus is also called the food pipe, and it connects your throat to your stomach.
People with BE have an increased risk for cancer in the area involved. However, cancer is not common.
Causes
When you eat, food passes from your throat to your stomach through the esophagus. A ring of muscle fibers in the lower esophagus keeps stomach contents from moving backward.
If these muscles do not close tightly, harsh stomach acid can leak into the esophagus. This is called reflux or gastroesophageal reflux (GERD). It may cause tissue damage over time. The lining becomes similar to that of the intestine.
Gastroesophageal reflux (GERD)
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). F...
Read Article Now Book Mark ArticleBE occurs more often in men than women. People who have had GERD for a long time are more likely to have this condition.
Symptoms
BE itself does not cause symptoms. The acid reflux that causes BE often leads to symptoms of heartburn. Many people with this condition do not have any symptoms.
Acid reflux
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backward from the stomach into the esophagus (food pipe). F...
Read Article Now Book Mark ArticleExams and Tests
Your health care provider will recommend an endoscopy (EGD) to screen for BE if you are a high risk person. You may also need an endoscopy if GERD symptoms are severe or come back after treatment.
Endoscopy
Endoscopy is a way of looking inside the body using a flexible tube that has a small camera and light on the end of it. This instrument is called an...
Read Article Now Book Mark ArticleDuring the endoscopy, your endoscopist (usually a gastroenterologist or specialist in conditions of the GI tract) may take tissue samples (biopsies) from different parts of the esophagus. These samples help detect the condition. They also help look for changes that could lead to cancer.
Biopsies
A biopsy is the removal of a small piece of tissue for laboratory examination.
Read Article Now Book Mark ArticleIf you have BE, your provider may recommend a follow-up endoscopy to look for cell changes that indicate cancer at regular intervals.
Some patients may choose to screen with a swallowed capsule, but this is not widely available.
Treatment
TREATMENT OF GERD
Treatment should improve acid reflux symptoms, and may keep BE from getting worse. Treatment of GERD may involve lifestyle changes and medicines such as:
Acid reflux symptoms
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from...
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Antacids after meals and at bedtime
Antacids
Antacids help to treat heartburn (indigestion). They work by neutralizing the stomach acid that causes heartburn. You can buy many antacids without ...
Read Article Now Book Mark Article - Histamine H2 receptor blockers
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Proton pump inhibitors (PPIs)
Proton pump inhibitors
Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.
Read Article Now Book Mark Article - Avoiding use of tobacco, chocolate, and caffeine
- However in BE, PPIs are the recommended medicine
Lifestyle changes, medicines, and anti-reflux surgery may help with symptoms of GERD. However, these steps will not make BE go away.
Anti-reflux surgery
Anti-reflux surgery is a treatment for acid reflux, also known as GERD (gastroesophageal reflux disease). GERD is a condition in which food or stoma...
Read Article Now Book Mark ArticleTREATMENT OF BARRETT ESOPHAGUS
Endoscopic biopsy can show changes in the cells of the esophagus that may be cancer. You provider may advise surgery or other procedures to treat it.
The recommended procedure to treat abnormal tissues in BE is radiofrequency ablation (RFA), which is done at the time of an endoscopy. Sometimes this is combined with endoscopic removal of particular sections of abnormal tissue. After RFA you will have follow-up endoscopy and further treatment if necessary.
Some people may choose to have surgery to correct anatomic abnormalities such as hiatal hernia, that may lead to BE.
If you have esophageal cancer, you may need surgery to remove the esophagus (esophagectomy).
Outlook (Prognosis)
Treatment should improve acid reflux symptoms and may keep BE from getting worse. RFA removes the BE tissue as does endoscopic removal, but BE often comes back and this is why surveillance with EGDs is done after RFA.
People with chronic GERD or BE generally need to be monitored for cancer of the esophagus.
When to Contact a Medical Professional
Contact your provider if:
- Heartburn lasts for longer than a few days, or you have pain or problems swallowing.
- You have been diagnosed with BE and your symptoms get worse.
- You develop new symptoms (such as weight loss, problems swallowing).
Prevention
Early detection and treatment of GERD may prevent BE.
References
Cameron J. Esophagus. In: Cameron J, ed. Current Surgical Therapy. 14th ed. Philadelphia, PA: Elsevier; 2023:chap 1.
Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 124.
Ku GY, Ilson DH. Cancer of the esophagus. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 71.
Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: An updated ACG Guideline. Am J Gastroenterol. 2022;117(4):559-587. PMID: 35354777 pubmed.ncbi.nlm.nih.gov/35354777/.
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Esophagus and stomach anatomy - illustration
Food is swallowed and passes through the esophagus to the stomach, where the majority of digestion takes place.
Esophagus and stomach anatomy
illustration
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Esophagus and stomach anatomy - illustration
Food is swallowed and passes through the esophagus to the stomach, where the majority of digestion takes place.
Esophagus and stomach anatomy
illustration
Review Date: 3/31/2024
Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.