What is Barrett’s esophagus?

Barrett’s esophagus (also sometimes called Barrett’s disease or Barrett’s syndrome) is a precancerous condition caused by uncontrolled acid reflux or gastroesophageal reflux disease (GERD).

It happens when corrosive stomach acid seeps back up into your esophagus due to a faulty ring of muscle called a sphincter between the two organs. This causes chronic inflammation that triggers intestinal metaplasia, a process in which the normal cells lining the esophagus are replaced by intestinal-type cells.

Given enough time, some of those altered cells can turn cancerous. So, how do you know if you have Barrett’s esophagus? What are its symptoms? And, how is it treated?

Read on, for the answers to these questions and more.

What are the symptoms of Barrett’s esophagus?

The problem with Barrett’s esophagus is that the condition itself does not cause any symptoms. There’s no telltale sign like blood in your stool or bloody vomit to alert you to the problem. The only symptoms you might have are those of acid reflux. So, a lot of people tend to blow it off.

What does acid reflux feel like?

It’s usually described as a burning sensation in the chest, like heartburn or indigestion. But it can also feel like chest pain or pain in the upper abdomen. In some cases, it can even cause a sore or scratchy throat, coughing, hoarseness or difficulty swallowing.

What are the red flags of Barrett’s esophagus?

Any time you start feeling like food is getting stuck in your throat, it should be promptly investigated. You could have Barrett’s esophagus or even an early tumor.

How is Barrett’s esophagus usually diagnosed?

The only way to definitively diagnose Barrett’s esophagus is to retrieve cells from the lining of your esophagus and biopsy them. At UT MD Anderson, we typically do this by having a gastroenterologist perform an upper endoscopy. We’ll pass a lighted, flexible scope down your throat while you’re sedated to gather tissue samples, then analyze them in a lab. This is the most common way to retrieve cells from your esophagus for biopsy.

Another method of collecting cells has been developed in the United Kingdom. It’s called a cyto-sponge or a capsule sponge test. Patients swallow a small capsule attached to a sterile string, then wait for the capsule’s gelatin covering to dissolve. Once that happens, the small sponge inside unfurls and a nurse gently pulls it out. The sponge gathers cell samples along the way as it scrapes past the surface of the esophagus.

Studies of the capsule sponge test in England indicate that it’s fairly sensitive. But an upper endoscopy is still the gold standard here in the U.S. because it can give you additional information. With an endoscopy, we can also see strictures (narrowed areas), as well as inflammation, polyps and even cancerous lesions and nodules. So, it offers a much more complete evaluation.

Is acid reflux the only cause of Barrett’s esophagus?

No. But it’s definitely the main reason, particularly if you have chronic, untreated symptoms.

What can help with acid reflux?

Proton pump inhibitors (PPIs) such as omeprazole, esomeprazole and lansoprazole all reduce the amount of acid produced by the stomach.

At UT MD Anderson, we advise avoiding anything that worsens acid reflux, because the body doesn’t like inflammation. This includes:

• Alcoholic beverages
• Big meals or large portions
• Caffeine
• Chocolate
• High-fat foods
• Late-night snacks or meals: defined as eating less than four hours before bedtime
• Smoking

How is Barrett’s esophagus treated?

Here at UT MD Anderson, Barrett’s esophagus is usually treated with something called endoscopic ablation therapy. There are two kinds: one uses extreme heat to kill abnormal cells, while the other uses extreme cold. The hot version is called radiofrequency ablation. The cold version has two subtypes: cryoballoon and cryospray ablation.

There’s also a third therapy called argon plasma coagulation (APC) that uses an electric spark to turn an inert gas into a plasma that kills abnormal cells. But ablation therapy is still considered the most effective method, because it can get rid of Barrett’s esophagus in the majority of cases.

What’s the best way to heal Barrett’s esophagus?

The only way to get rid of it is through treatment. Barrett’s esophagus won’t go away without it. Even then, there’s still about a 14-20% chance of recurrence.

Is Barrett’s esophagus considered serious?

Yes. Some people with Barrett’s esophagus will never develop cancer. But we cannot tell which ones. So, once you’ve been diagnosed with it, you’ll need surveillance for the rest of your life.

If you have Barrett’s esophagus with high-grade dysplasia, you’ll also need treatment pretty quickly.

Can Barrett’s esophagus kill you?

By itself, no. But if it progresses to cancer and is left untreated, then yes. That’s why it’s so important to continue getting follow-up care to monitor this condition once you get a diagnosis.

Will everyone who is diagnosed with Barrett’s esophagus need treatment?

Not necessarily. The road between Barrett’s esophagus and cancer can be quite long. And, the risk of progression is relatively low for patients with Barrett’s alone: only about 0.12% per additional year of life after diagnosis.

But it also depends on how unusual or disorganized your cells look under a microscope. That change is called dysplasia. If our pathologists here at UT MD Anderson find:

• Barrett’s without dysplasia: We may just recommend surveillance. That means you’ll need to come in every 3-5 years for another upper endoscopy so we can watch it.
• Barrett’s with low-grade dysplasia: You may need to undergo a surveillance endoscopy every year or be a candidate for treatment.
• Barrett’s with high-grade dysplasia: We’ll likely recommend treatment right away, because those cells are at higher risk of turning into cancer.

In UT MD Anderson’s Barrett’s Esophagus Clinic, we may also offer you treatment if you have no dysplasia but you do have Barrett’s esophagus and a family history of esophageal cancer.

Aside from acid reflux, are there any other risk factors for Barrett’s esophagus?

Yes. It’s most often found in older, overweight white men. Being white is a big risk factor, as are being male and obese.

Which types of cancer can you get from Barrett’s esophagus?

Barrett’s esophagus leads to a type of cancer called esophageal adenocarcinoma. But it’s completely different from squamous cell carcinoma, so it’s not related to the esophageal cancer normally associated with smoking or alcohol use.

Why is it important to seek care from a specialist for Barrett’s esophagus?

It’s all about the quality of your exam and the expertise of your doctors.

Any gastroenterologist can do an upper endoscopy. But there are specific guidelines for investigating Barrett’s esophagus, and a regular gastroenterologist may not know or follow the recommended protocol to find it. If they don’t perform enough biopsies, they might not find dysplasia. And, you don’t want to miss dysplasia.

I can’t tell you how many patients say, “But I just had an upper endoscopy done last year, and the doctor said everything looked great!” It happens all the time. So, you want to make sure you’re getting a high-quality exam from a team that specializes in Barrett’s esophagus and sees a high volume of patients with that condition.

Here at UT MD Anderson, we have a dedicated Barrett’s Esophagus Clinic, where our gastroenterologists look at the lining of the esophagus with several different lights to better spot any abnormalities. We also have pathologists who specialize in this condition that review the tissue samples. That makes a big difference.

Marta Davila, M.D., is a gastroenterologist who specializes in endoscopic procedures at UT MD Anderson.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.