Barrett's Esophagus

Barrett’s esophagus is a condition in which the esophagus – the tube connecting your mouth and your stomach – is damaged by stomach acids. The tissue in the esophagus is replaced by tissue similar to what is in the stomach and intestines.

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic condition in which acid from the stomach refluxes into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus. Barrett’s esophagus is occurs more often in men than in women. Caucasian people are more likely to develop Barrett’s esophagus than people of other races. The condition is usually diagnosed after age 50 and the condition is rare in children.

Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus can causes symptoms of heartburn.

People with Barrett's esophagus have an increased risk for esophageal cancer. However, this risk is still very low and the cancer is uncommon.

Diagnosis and treatment of GERD should improve acid reflux symptoms and may keep Barrett's esophagus from getting worse.

The tissue changes associated with Barrett's esophagus cause no symptoms. Signs and symptoms experienced by people with this condition are generally due to GERD and may include:

• Frequent heartburn
• Difficulty swallowing food
• Chest pain

The exact cause of Barrett’s esophagus is unknown. However, some factors can increase or decrease your chance of developing Barrett’s esophagus.

Having GERD increases your chances of developing Barrett’s esophagus. GERD is a chronic form of gastroesophageal reflux, a condition in which stomach contents reflux back up into your esophagus. Refluxed stomach acid that touches the lining of your esophagus can cause heartburn and damage the cells in your esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus, which are similar to those found in the stomach. Between 5% and 10% of people with GERD develop Barrett’s esophagus.

Obesity and smoking also increase your chances of developing Barrett’s esophagus. Some studies suggest that your genetics, or inherited genes, may play a role in whether or not you develop Barrett’s esophagus.

Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. This bacteria damage your stomach and the tissue in your intestines and cause ulcers, and some researchers believe the bacteria makes your stomach contents less damaging to your esophagus if you have GERD.

Factors that may decrease the chance of developing Barrett’s esophagus include frequent use of aspirin or other nonsteroidal anti-inflammatory drugs and a diet high in fruits, vegetables, and certain vitamins​.

If you have experienced heartburn and acid reflux for more than 5 years, ask your doctor about your risk of Barrett's esophagus. Seek immediate help if you:

• Experience heartburn that lasts longer than a few days
• Develop new symptoms, such as weight loss
• Have chest pain, which may be a symptom of a heart attack
• Have difficulty swallowing
• Are vomiting red blood or blood that looks like coffee grounds
• Are passing black, tarry or bloody stools
• Have been diagnosed with Barrett’s esophagus and your symptoms get worse

Your doctor will ask you to provide your medical history. Your doctor may recommend testing if you have multiple factors that increase your chances of developing Barrett’s esophagus.

Doctors diagnose Barrett’s esophagus with an upper gastrointestinal (GI) endoscopy and a biopsy. Barrett’s esophagus may be diagnosed while performing tests to find the cause of a patient’s GERD symptoms.

Lifestyle changes can ease symptoms of GERD, which may influence the development of Barrett's esophagus. Patients with GERD should:

• Maintain a healthy weight
• Avoid tightfitting clothes, which can put pressure on your abdomen and aggravate reflux
• Eliminate foods and drinks that trigger your heartburn
• Stop smoking
• Avoid stooping or bending, especially soon after eating
• Avoid lying down after eating
• Raise the head of your bed

Treatment should aim to improve acid reflux symptoms, which may keep Barrett's esophagus from getting worse. Treatment may involve lifestyle changes and medicines such as:

• Acid-reducing agents called antacids such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Riopan, Rolaids
• Anti-secretory medications including as H2-blockers, such as cimetidine (Tagamet), famotidine (Pepcid AC), nizatidine (Axid), and ranitidine (Zantac), and proton-pump inhibitors, including esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), antoprazole (Protonix), and rabeprazole (Aciphex)
• Lifestyle changes and medicines may help with symptoms of GERD. However, these steps will not make Barrett's esophagus go away.
• Surgery or other procedures may be recommended if a biopsy shows cell changes may cancer.
• Some of the following procedures remove the harmful tissue in your esophagus:
• Photodynamic therapy (PDT) uses a special laser device, called an esophageal balloon, along with a drug called Photofrin to remove harmful tissue
• Other procedures use different types of high energy to destroy the precancerous tissue
• Surgery removes the abnormal lining