Barrett’s esophagus is a complication of gastroesophageal reflux disease (GERD). Barrett’s esophagus occurs when the normal cells lining the lower esophagus are replaced by intestinal type cells (intestinal metaplasia). This is thought to be due to the repetitive damage to the esophageal ligning from chronic acid reflux.
- Age: Barrett’s is usually diagnosed in middle aged adults but it can occur in younger patients.
- Gender: Men are more likely to develop Barrett’s than women.
- Ethnicity: Caucasians are at increased risk of developing Barrett’s.
- Obesity: abdominal obesity increases the risk.
Barrett’s esophagus does not cause any symptoms. Patients usually present for evaluation due to symptoms from acid reflux such as heartburn.
When to see a doctor:
If you have chronic heartburn and GERD ask your doctor about your risk of developing Barrett’s esophagus. You should seek immediate medical attention if you have one of the following:
- Chest pain
- Difficulty swallowing food
- Vomiting blood
- Passing black stools
Barrett’s esophagus is a premalignant condition. The risk of developing esophageal cancer is very low (less than 0.5% per year), but the risk increases if there are certain precancerous changes noted on the biopsies (dysplasia). It is important to note that most people with Barrett’s esophagus do not develop esophageal cancer.
Upper endoscopy: while you are sedated the doctor inserts a thin tube with a camera and a light at its tip from your mouth down to the esophagus. If the appearance of the esophageal lining is suggestive of Barrett’s, the doctor will take small pieces of tissue from the esophageal lining (biopsies). The tissue will be examined under the microscope to determine if you have Barrett’s and if you do whether there is any evidence of dysplasia.
- Endoscopic surveillance: if you are diagnosed with Barrett’s esophagus your doctor would most likely recommend repeating an endoscopy in one year to confirm the diagnosis and make sure there is no dysplasia. Then surveillance is performed every three years. If dysplasia is detected your doctor would either recommend a more intensive surveillance program or one of the following interventions.
- Endoscopic mucosal resection: an upper endoscopy is performed and large but thin areas of the esophagus are removed through the endoscope.
- Radiofrequency ablation: an upper endoscopy is performed radiofrequency energy is used to destroy the Barrett’s cells.
- Surgery: part of your esophagus is removed and the remaining portion is attached to the stomach.