Barrett’s Esophagus

What is Barrett’s esophagus?
Barrett’s esophagus describes a condition in which the normal skin-like tissue lining the esophagus is replaced by tissue similar to the lining of the stomach or intestine. Barrett’s esophagus is a complication of chronic gastroesophageal reflux disease (GERD), in which acidic fluid from the stomach regurgitates into the esophagus. GERD symptoms are often referred to as “heartburn.” Each year, less than 1 percent of people with Barrett’s esophagus develop esophageal cancer.

Who is likely to have Barrett’s esophagus?
Barrett’s esophagus affects about 1 percent of U.S. adults. Among those with GERD, about 10 to 15 percent develop Barrett’s esophagus. The average age at diagnosis is 50, but the problem often starts at an earlier age. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.

What characterizes Barrett’s esophagus?
Barrett’s esophagus has no signs or symptoms other than it is commonly found in people with GERD. In addition to heartburn and regurgitation, GERD symptoms include adult-onset asthma, frequent bronchitis, chronic cough, sore throat, hoarseness, and difficulty swallowing. The change in tissue type in the esophagus is believed to be a protective response because the tissue similar to the stomach or intestinal lining is more resistant to injury from acid than is the original esophageal tissue.

How does the pathologist make the diagnosis?
To diagnose Barrett’s esophagus, an esophageal endoscopy is performed. In this procedure, a tube is inserted through the mouth and down the esophagus to view and gather a biopsy specimen from the tissue lining the esophagus. Two indicators of Barrett’s esophagus are abnormal pink tissue extending up from the lower section of the esophagus and the presence of intestinal cells called goblet cells.

What else does the pathologist look for?
The pathologist looks for early warnings of cancer, or cancer itself. Sometimes, before cancer develops, precancerous cells appear in Barrett’s tissue. This condition, called dysplasia, is often diagnosed after multiple biopsies because dysplasia can be missed in a single biopsy. Detecting and treating dysplasia may prevent cancer from developing.

How do doctors determine what treatment will be necessary?
Your treatment will depend on whether or not severe (high grade) dysplasia or cancer is found. Medical professionals, including pathologists, oncologists, and radiologists, use their combined experience and knowledge and recommend treatment options most appropriate for your condition. It’s important to learn as much as you can about your treatment options and make the decision that’s right for you.

What kinds of treatments are available for Barrett’s esophagus?
If severe (high grade) dysplasia or cancer is not found, your primary care physician may recommend surveillance, during which time you will receive endoscopic procedures periodically to gather biopsy specimens that will be examined by a pathologist. You also will continue to be treated for GERD, whether or not dysplasia or cancer is found. These treatments suppress acid and other symptoms with over-the-counter or prescription medications. In some cases, anti-reflux surgery may be recommended to tighten up the junction between the stomach and esophagus. It’s also important to follow a proper diet, avoid smoking and excessive alcohol consumption, avoid food and fluids for 90 to 120 minutes before bed, and elevate your upper body when lying in bed.

If the patient can tolerate it, surgery may provide the best chance of a cure and may be recommended for severe dysplasia or cancer. The surgical procedure usually involves removing most of the esophagus, pulling a portion of the stomach up, and attaching it to what remains of the esophagus.

However, because many people with Barrett’s esophagus are older and have medical problems, endoscopy treatments that destroy or remove the precancerous or cancerous cells may be preferable. One treatment, photodynamic therapy, uses a light-sensitizing agent called Photofrin and a laser to kill these cells. Another treatment, called endoscopic mucosal resection, involves lifting the tissue lining and injecting a solution under it or applying suction to it and cutting it off. If this procedure is used to treat cancer, an endoscopic ultrasound is done first to make sure the cancer is present only in the top layer of esophageal cells.

Patients should consider enrolling in a clinical trial, which tests new treatments. These treatments are experimental in nature but may be an option. Clinical trials for Barrett’s esophagus may be found at www.clinicaltrials.gov.

For more information, go to http://digestive.niddk.nih.gov (National Digestive Diseases Information Clearinghouse— NDDIC) or www.webmd.com. Type the keywords Barrett’s esophagus into the search box.

What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

  • Please describe the type of cancer I have and what treatment options are available.
  • What treatment options do you recommend? Why do you believe these are the best treatments?
  • What are the pros and cons of these treatment options?
  • What are the side effects?
  • Is your medical team experienced in treating the type of cancer I have?
  • Can you provide me with information about the physicians and others on the medical team?
  • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS


Esophagus: The muscular tube that passes food from the mouth to the stomach.

Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions. 

Dysplasia: Abnormal precancerous cell development.

 

Images

Barrett’s esophageal cells  NORMAL

Barrett’s esophageal cells
Normal esophageal cells
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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