Barrett's Esophagus

Barrett's esophagus is a chronic condition in which the lining of the esophagus — the "food tube" that connects the throat to the stomach — is damaged by bile or acid from the stomach. The damage is characterized by changes in the cells at the base of the esophagus. The esophageal cells gradually elongate and thicken, and eventually come to resemble intestinal cells.

Normally, the body has a mechanism to prevent stomach acid from reaching the esophagus. A circular band of muscle at the lower end of the esophagus, called the lower esophageal sphincter, seals shut and prevents stomach contents from rising up. But certain conditions, such as chronic gastroesophageal reflux disease (GERD) or obesity, weaken the sphincter. When that happens, stomach acid can gurgle up and burn the lower end of the esophagus.

Occasional heartburn is harmless, but chronic GERD can set the stage for Barrett's esophagus. Experts estimate that between 10 and 15 percent of people with GERD will develop Barrett's esophagus.

Barrett's esophagus is serious because it increases a person's risk for a type of cancer called esophageal adenocarcinoma. In most cases, precancerous cells, called dysplasia, appear first and offer a chance for early intervention.

Barrett's esophagus itself has no symptoms but its precursor, gastroesophageal reflux disease (GERD), does. Signs of GERD include regular heartburn, which is often described as a painful burning sensation either in the chest, behind the breastbone, or in the middle of the abdomen.

However, not all people with Barrett's esophagus have chronic heartburn. As many as half of all Barrett's esophagus patients don't have any symptoms at all. Because the condition can go undetected, it's good to know about other risk factors for Barrett's esophagus, which include:

  • Obesity
  • Smoking
  • Gender (men are twice as likely as women to get Barrett's esophagus)
  • Age (Barrett's esophagus is more common in people age 50 or older)
  • A close family member with the condition

Barrett's esophagus is diagnosed with an upper gastrointestinal (GI) endoscopy and biopsies.

To perform an upper GI endoscopy, a doctor threads a thin, flexible tube through the mouth, down the esophagus and into the stomach while the patient is lightly sedated. The endoscope has a flashlight and camera on one end that allows the doctor to inspect the esophageal lining for cellular changes that might indicate dysplasia. The doctor can also use the endoscope to take small tissue samples called biopsies. These samples help doctors diagnose the presence and grade of Barrett's esophagus.

New technologies also allow doctors to do optical biopsies, which don't involve removing any tissue at all.

The results may be labeled one of the following:

  • No dysplasia, meaning the patient has Barrett's esophagus but no precancerous cellular changes
  • Low-grade dysplasia, meaning cells show early signs of precancerous changes
  • High-grade dysplasia, meaning cells are moving toward esophageal cancer

Treatment of Barrett's esophagus depends on the condition's severity, the grade of dysplasia and the patient's overall health.

The first line of treatment is often surveillance and medication. If the biopsy shows no or even low-grade dysplasia, we may simply monitor the patient for changes. That may mean a follow-up endoscopy in six months to a year and, for some patients, daily medication.

For Bartlett's esophagus, the most common type of drug therapy is proton pump inhibitors, or PPIs. These medications are designed to treat GERD and work by suppressing the stomach's acid production. Less stomach acid means less damage to the esophagus. PPIs are best taken short term. Examples of common PPIs include:

  • Omeprazole (Prilosec, Zegerid)
  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)
  • Esomeprazole (Nexium)
  • Dexlansoprazole (Dexilant)

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Reviewed by health care specialists at UCSF Medical Center.

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