Causes

When you eat, food passes from your throat to your stomach through the esophagus (also called the food pipe or swallowing tube). Once food is in the stomach, a ring of muscles keeps it from leaking backward into the esophagus.

If these muscles do not close tightly, stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux.

Reflux may cause symptoms of heartburn. It may also damage the lining of the esophagus. The esophagus lining then changes in appearance and looks like the stomach lining (Barrett's esophagus).

Barrett's esophagus occurs more often in men than women. You are more likely to have this condition if you have had GERD for a long time.

Patients with Barrett's esophagus may develop more changes in the esophagus called dysplasia. When dysplasia is present, the risk of getting cancer of the esophagus increases.

Symptoms

Barrett's esophagus itself does not cause symptoms. The acid reflux that causes Barrett's esophagus often leads to symptoms of heartburn. However, many patients with this condition do not have symptoms.

Exams and Tests

If GERD symptoms are severe or they come back after you have been treated, the doctor may perform an endoscopy.

• A thin tube with a camera on the end is inserted through your mouth and then passed into your esophagus and stomach.
• While looking at the esophagus with the endoscope, the doctor may perform biopsies in different parts of the esophagus. These biopsies help diagnose Barrett's esophagus, and look for changes that could lead to cancer.

People with Barrett's esophagus have an increased risk for esophageal cancer. Still, only a small number of people with Barrett's esophagus develop cancer. Your health care provider may recommend a follow-up endoscopy to look for changes that may lead to cancer (dysplasia), or for cancer itself.

Treatment

TREATMENT OF GERD

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

• Antacids after meals and at bedtime
• Histamine H2 receptor blockers
• Proton pump inhibitors

Lifestyle changes, medications, and anti-reflux surgery may help with symptoms of GERD, but will not make Barrett's esophagus go away.

TREATMENT OF BARRETT'S ESOPHAGUS

Surgery or other procedures may be recommended if a biopsy shows cell changes that are very likely to lead to cancer. Such changes are called severe or high-grade dysplasia.

Some of the following procedures remove the harmful tissue in your esophagus, where the cancer is most likely to develop.

• Photodynamic therapy (PDT) uses a special laser device, called an esophageal balloon, along with a drug called Photofrin.
• Other procedures use different types of high energy to destroy the precancerous tissue.
• Surgery removes the abnormal lining.

Outlook (Prognosis)

Treatment should improve acid reflux symptoms and may keep Barrett's esophagus from getting worse. None of these treatments will reverse the changes that may lead to cancer.

When to Contact a Medical Professional

Call your health care provider if:

• Heartburn lasts for longer than a few days, or you have pain or difficulty swallowing.
• You have been diagnosed with Barrett's esophagus and your symptoms get worse, or new symptoms (weight loss, problems swallowing) develop.

Prevention

Diagnosis and treatment of GERD may prevent Barrett's esophagus.

References

Spechler SJ, Souza RF. Barrett's esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 44.

Wang, KK and Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008;103:788-797.

Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009;360:2277-2288.

Updated: 4/11/2012

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.