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- Barrett’s Esophagus
Barrett’s Esophagus
What is Barrett’s esophagus
Barrett’s esophagus is a condition in which the normal lining of the esophagus changes to a different type of cell, most often near the area where the esophagus meets the stomach. This change, known as intestinal metaplasia, is thought to be the body’s response to ongoing inflammation and damage caused by long-term gastroesophageal reflux disease (GERD).
In Barrett’s esophagus, the new type of lining resembles the tissue normally found in the intestines, rather than the normal squamous cells of the esophagus. While Barrett’s esophagus itself is not cancer, it is considered a precancerous condition. A small number of patients may go on to develop dysplasia, or early abnormal cell changes, which can eventually progress to esophageal cancer if not identified and treated early.
Causes of Barrett’s esophagus
The primary cause of Barrett’s esophagus is chronic acid reflux. When stomach acid frequently flows backward into the esophagus, it irritates and inflames the lining. Over time, this irritation can lead to changes in the type of cells that line the lower esophagus.
People who have GERD for many years are at higher risk, especially if symptoms are not well controlled. Other risk factors include being male, over the age of 50, Caucasian, overweight, or having a history of smoking. While not everyone with GERD develops Barrett’s esophagus, having reflux symptoms, especially regurgitation and heartburn, can increase the likelihood.
Symptoms of Barrett’s esophagus
Barrett’s esophagus does not usually cause symptoms on its own. Most people who are diagnosed with this condition first experience symptoms of chronic gastroesophageal reflux disease (GERD). These symptoms may include frequent heartburn, regurgitation of food or sour liquid, chest discomfort, or a feeling of fullness in the upper abdomen. Some individuals may also experience trouble swallowing or a sensation that food is getting stuck in the throat or chest.
In many cases, Barrett’s esophagus is discovered during an endoscopy performed for persistent or severe GERD symptoms. Because the condition can progress without noticeable signs, regular follow-up and screening are important for people at higher risk. When the abnormal tissue begins to show precancerous changes, known as dysplasia, there may still be no additional symptoms, which is why surveillance is essential to detect early changes and reduce the risk of esophageal cancer.
Diagnosis of Barrett’s esophagus
Barrett’s esophagus is usually diagnosed during an upper endoscopy, a procedure where a thin, flexible tube with a camera is passed into the esophagus and stomach. During this test, doctors can directly see the lining of the esophagus and take small tissue samples (biopsies) to examine under a microscope. A diagnosis of Barrett’s esophagus is confirmed when the biopsy shows specific cell changes known as intestinal metaplasia.
Because Barrett’s esophagus often does not cause symptoms beyond typical GERD, such as heartburn or regurgitation, it is frequently discovered during evaluation for reflux, difficulty swallowing, or other chronic problems that do not improve with treatment.
Although most people with Barrett’s esophagus never develop cancer, the risk is higher than in the general population. The presence of dysplasia—especially high-grade dysplasia—means that the cells are beginning to show precancerous changes. For this reason, patients with Barrett’s esophagus are monitored closely over time with regular surveillance endoscopy.
Surveillance helps doctors detect changes early, before cancer develops. The timing and frequency of these procedures depend on whether dysplasia is present and how severe it is. In patients without dysplasia, follow-up endoscopy may be done every three to five years. For those with low-grade or high-grade dysplasia, more frequent evaluations and treatment are typically needed.
Treatment of Barrett’s esophagus
Treatment for Barrett’s esophagus depends on the degree of cell change, the presence of dysplasia, and the patient’s overall health. For many patients without dysplasia, managing GERD symptoms and reducing reflux with medications such as proton pump inhibitors (PPIs) may help reduce inflammation and protect the esophageal lining. Some patients may benefit from surgical or endoscopic procedures to repair a hiatal hernia, which can contribute to reflux by weakening the valve between the esophagus and stomach. Lifestyle changes like weight loss, dietary modifications, and avoiding tobacco or alcohol also play an important role.
When dysplasia is present or when early cancer is detected, more active treatment may be necessary. Several advanced endoscopic therapies are now available that can remove or destroy the abnormal cells without requiring open surgery.
One common option is radiofrequency ablation, which uses heat energy to destroy the abnormal lining while preserving the healthy tissue underneath. Another technique is cryotherapy, which uses cold energy to freeze and eliminate dysplastic cells. In some cases, endoscopic mucosal resection (EMR) is performed to remove larger areas of abnormal tissue.
UTHealth Houston Gastroenterology & Digestive Health offers expert diagnosis, personalized surveillance, and access to state-of-the-art treatments for patients with Barrett’s esophagus. A team-based approach helps ensure you receive the care and support needed to protect your long-term esophageal health.