An Overview of Barrett's Esophagus

When heartburn causes serious problems

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Barrett's esophagus is a rare, irreversible condition characterized by changes in the internal lining of the esophagus (food pipe). Recurrent and long-term gastroesophageal reflux disease (GERD), the backflow of stomach contents, is believed to be a cause. Barrett's esophagus does not usually cause any symptoms, but it may be associated with upper abdominal discomfort. The condition is concerning because it can be a precursor of esophageal cancer.

Diagnosis involves endoscopy, an interventional procedure in which a camera-equipped tube is placed down the throat to visualize the esophagus. If you have Barrett's esophagus, you may need to adjust your diet or take medication. In some instances, surgical intervention is necessary.

Symptoms

The esophageal lining changes that define Barrett's esophagus rarely present with any symptoms. Anything you do experience is likely owed to the persistent GERD that caused your condition in the first place.

Symptoms of GERD include:

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

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

Spicy foods, caffeine, fried foods, and high-fat foods can exacerbate your symptoms.

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. Signs can include weight loss, blood in the stool, vomiting (possibly blood-tinged), severe abdominal pain, or trouble swallowing.

Causes

The lower esophageal sphincter (LES) is a muscle that separates your esophagus from your stomach. The LES 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 acid to flow into the esophagus when it would normally be kept out.

It's exposure to this caustic fluid that causes damage to the lower esophageal lining, actually changing the tissue permanently.

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.

Barrett's esophagus 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 is the leading risk factor for Barrett's esophagus, but there are other notable ones to be aware of:

  • Smoking
  • Obesity
  • Older age (55 is the most common age at diagnosis)
  • Heartburn (with or without GERD)
  • Hiatal hernia

Diagnosis

A diagnosis of Barrett's esophagus usually relies on several steps. The first will be an esophagogastroduodenoscopy (EGD), which can visualize the columnar epithelium in the lower esophagus.

Depending on what your doctor observes, additional testing may be necessary to make a diagnosis, identify complications, and/or help guide your treatment plan.

If you have risk factors for developing serious gastrointestinal problems, an endoscopy 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 this done.

Biopsy

During a biopsy your medical team will surgically remove a small sample of tissue from your esophagus. This is typically done with endoscopic guidance and delivery of pain medication.

The sample collected are then viewed under a microscope to check for the presence of 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.

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.

This may 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 in 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 are several strategies that can help manage the condition and prevent it from worsening.

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 stay sitting up 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 one or more of the following to help relieve symptoms of heartburn and protect the lining of your lower esophagus:

  • Antacids, such as TUMS, Alka-Seltzer, and Pepto-Bismol (bismuth subsalicylate)
  • Proton pump inhibitors (PPI), such as Prilosec (omeprazole), Prevacid (lansoprazole), and Nexium (esomeprazole)
  • H2 blockers, such as Pepcid AC (famotidine) and Axid AR (nizatidine)

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 options for removing esophageal tissue. The right procedure for you depends on the location, extent, 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 opt to use:

  • A surgical procedure to completely remove the tumor.
  • Photodynamic therapy (PDT): This uses a chemical called Photofrin, which makes the tissue more sensitive to light. It is administered intravenously over the course of three to five minutes. 
  • Radiofrequency ablation (RFA): Radiowaves heat the abnormal tissue to eliminate it.
  • Cryotherapy: Very cold temperatures are used to destroy altered esophageal tissue.

The procedures listed above other than surgery do contain some limitations, however. Specifically, the cells that are destroyed via PDT, RFA, or cryotherapy are not then able to be examined microscopically so one can not be sure of the nature of the cancer and whether it has been fully removed with a good margin.

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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Article Sources
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