An Overview of Barrett's Esophagus

When heartburn causes serious problems

Barrett's esophagus is a rare condition characterized by changes in the internal lining of the esophagus (food pipe). This condition does not usually cause any symptoms, but it may be associated with upper abdominal discomfort. Barrett's esophagus is concerning because it can be a precursor of esophageal cancer.

Recurrent and long term reflux (backflow) of stomach contents into the esophagus is believed to be the cause of Barrett's esophagus. Diagnosis involves endoscopy—an interventional procedure in which a camera-equipped tube is placed down the throat to visualize the esophagus.

You may need to adjust your diet or take medication if you are diagnosed with Barrett's esophagus. In some instances, surgical intervention is necessary to remove the altered esophageal tissue.

Symptoms

Usually, Barrett's esophagus is asymptomatic (without symptoms). There are some associated effects you can look out for, but most people do not experience them (or only have associated symptoms very rarely).

The complications of Barrett's esophagus may cause serious health effects, so it is best to try to identify the problem before any complications develop.

Prior to and after developing Barrett's esophagus, you can experience:

  • A burning sensation of your upper abdomen
  • Upper abdominal discomfort
  • Burping
  • A bitter or sour taste in your mouth
  • Bad breath
  • Symptoms of heartburn

You are most likely to experience symptoms associated with Barrett's esophagus within an hour after eating. Once they begin, the effects can last for several hours. The symptoms associated with Barrett's esophagus are generally worse if you lie down shortly after eating.

Certain foods and drinks can exacerbate your symptoms—such as spicy foods, caffeine, fried foods, and high-fat foods.

Complications

The most worrisome aspect of Barrett's esophagus is that it is a risk factor for developing esophageal cancer. Specifically, adenocarcinoma of the lower esophagus can develop due to Barrett's esophagus.

This type of cancer might not cause any symptoms until it reaches a late stage. Eventually, you may experience the effects of esophageal adenocarcinoma if the tumor becomes enlarged or invades nearby tissue. Effects can include weight loss, blood in the stool, vomiting (possibly blood-tinged), severe abdominal pain, or trouble swallowing.

Causes

Barrett's esophagus affects adults over the age of 60. It is more common among men than women, and there are several lifestyle risk factors associated with the condition. Additionally, you may be at higher risk of developing Barrett's esophagus if it runs in your family.

Gastroesophageal reflux disease (GERD) is the leading risk factor for Barrett's esophagus.

Other risk factors associated with Barrett's esophagus, include:

  • Smoking
  • Obesity
  • Older age
  • Heartburn (with or without GERD)
  • Hiatal hernia

How Barrett's Esophagus Develops

The lower esophageal sphincter is a muscle that separates your esophagus from your stomach. This sphincter can become weakened due to factors such as smoking or a hiatal hernia, and it is commonly weakened in GERD. A weak lower esophageal sphincter allows stomach fluid to flow into the esophagus (normally, this shouldn't happen).

Stomach fluid is typically very acidic. Exposure to acidic stomach fluid is not optimal for the esophagus—and it causes damage to the lower esophageal lining.

In response to chronic (recurrent and long term) damage, the esophageal lining actually changes.

With Barrett's esophagus, the lower esophagus begins to develop a type of lining that is described as columnar epithelium. This lining is typical of the intestines, but not the esophagus. This esophageal change doesn't usually cause noticeable effects, but it can eventually transform into cancer.

The columnar epithelium in the lower esophagus can be visualized with an endoscopy examination.

Diagnosis

A diagnosis of Barrett's esophagus usually relies on several steps. You will likely need to have an endoscopy. If your esophagus shows signs of altered tissue lining on your endoscopy, you may need further testing, such as a biopsy.

Additionally, you may need imaging tests, blood tests, or an evaluation of your stool to identify complications and help guide your treatment plan.

If you have risk factors for developing serious gastrointestinal problems, an esophagogastroduodenoscopy (EGD) may be recommended as a screening test for Barrett's esophagus and other conditions—even if you do not have any symptoms.

Endoscopy

An endoscopy is an interventional procedure. During this procedure, you will have a tube with an attached camera placed down your throat. You will need medication to help you relax and prevent you from gagging during this test.

During your endoscopy, your doctor will be able to see whether or not you have developed columnar epithelial cells at the distal (bottom) portion of your esophagus. These cellular changes cause the color and appearance of your lower esophagus to change.

If there are concerning changes seen in your esophagus during your endoscopy, you may have a biopsy during the procedure, or you may need another appointment to have a biopsy.

Biopsy

A biopsy of your esophagus allows your medical team to look at the appearance of your lower esophageal cells under a microscope.

During a biopsy, your medical team will surgically remove a small sample of tissue from your esophagus. This is typically done with endoscopic guidance. You will need pain medication during the procedure. After a lower esophageal biopsy, your esophagus should heal fairly quickly. You may be instructed to eat certain foods for a few days while you are healing.

Your biopsy tissue sample can help your doctors see if the cells of your lower esophagus contain columnar epithelium.

Additionally, your medical team will evaluate your biopsy sample to see if you have signs of dysplasia. This is a type of abnormal cellular change that is associated with precancerous features. For example, if the cells of Barrett's esophagus appear as normal columnar epithelium, this would not be described as dysplasia. But if they start to look like dysfunctional cells, they would be described as showing features of dysplasia.

Associated Diagnostic Tests

Depending on your symptoms and the results of your preliminary tests, you may need additional testing.

Diagnostic tests that you may need to have include:

  • Blood tests, such as a complete blood count (CBC) may be necessary if there is a concern that you could be losing blood due to bleeding of your esophagus.
  • Imaging tests, such as computerized tomography (CT) of your chest and/or abdomen can be helpful if there is any concern that you could have a large growth, abscess, or blockage in your stomach or esophagus.
  • A fecal occult blood test can be used to detect blood in your stool. Blood is often a sign of bleeding or cancer in the digestive system.

Treatment

There is no treatment that can reverse Barrett's esophagus, but there are several strategies that can help manage the condition and prevent it from worsening. If you have advanced disease or precancerous cells, you may need to have surgery to remove the altered cells.

Lifestyle Management

If you have Barrett's esophagus or risk factors such as GERD or heartburn, you can minimize the effects by avoiding foods and beverages that exacerbate the condition. It is also helpful to avoid lying down for an hour or more after you eat.

Weight loss and smoking cessation can help prevent Barrett's esophagus from worsening.

Medications

Several over-the-counter (OTC) and prescription medications can reduce the acidity of the fluid in your lower esophagus. Your doctor may recommend an antacid, proton pump inhibitor, and/or an H2 blocker to help relieve symptoms of heartburn and to help protect the lining of your lower esophagus.

Procedures and Surgery

With Barrett's esophagus, dysplasia, or cancer, you may need to have a resection (removal) or the cells in your lower esophagus. There are several methods used for removing esophageal tissue. The right procedure for you depends on the location, size, and type of changes you have in your esophagus.

You may need to have a surgical procedure with general anesthesia, or you might have a minimally invasive procedure in which your doctor uses endoscopic guidance to remove altered esophageal tissue.

Sometimes, the cells can be destroyed rather than removed. Your medical team may use photodynamic therapy (PDT). This therapy uses a chemical called Photofrin, which makes the tissue more sensitive to light. Radiofrequency ablation (destruction) can be used to eliminate the abnormal tissue. And cryotherapy, which uses very cold temperatures, can destroy altered esophageal tissue as well.

A Word From Verywell

Barrett's esophagus is not common, but you may need to be monitored for this condition if you have GERD or if you experience heartburn. Because Barrett's esophagus is considered a risk factor for esophageal cancer, it is important that your medical team identifies it at an early stage and that you continue to maintain close monitoring if you have it.

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