Barrett’s esophagus occurs when the normal lining of the esophagus is replaced with different tissue. This altered tissue is similar to that which lines the intestine.
The esophagus is the tube that connects the mouth to the stomach. This tissue replacement is referred to as intestinal metaplasia.
The cause of this rare condition is not entirely known, and it occurs in approximately 1.6 to 3 percent of people.
People with Barrett’s esophagus face an increased risk of developing esophageal adenocarcinoma, a rare form of cancer.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this cancer affects 0.5 percent of people with Barrett’s esophagus each year.
Individuals with long-term gastroesophageal reflux disease (GERD) most commonly have Barrett’s esophagus.
Many people who have developed Barrett’s also experience the symptoms of GERD.
These symptoms include:
- Heartburn: This is a burning sensation in the chest.
- Dysphagia: A person may experience difficulty swallowing their food.
- Chest pain: The condition can cause discomfort and burning behind the ribcage.
The majority of people with Barrett’s do not experience any symptoms at all.
Certain foods and drinks can trigger GERD and eventually lead to Barrett’s esophagus. People who eliminate them from the diets can reduce their symptoms.
Food and drinks that can trigger inflammation in the esophagus include:
- fatty foods
- greasy foods
- spicy foods
- tomatoes and tomato-based products
Eating small, frequent meals instead of three large meals can also help reduce the symptoms of GERD.
Certain groups are at a higher risk of developing Barrett’s.
The NIDDK state that between 5 and 10 percent of people with GERD also develop the condition.
People at an increased risk include:
- those with overweight and obesity
- people who have had GERD for more than 5 years
- individuals with GERD who are over 50 years of age and taking regular medication
- people who smoke tobacco
Those under the age of 30 years when their chronic GERD begins may face a higher risk.
According to the NIDDK, males develop Barrett’s esophagus twice as often as females.
There are also several factors that could reduce the risk of Barrett’s esophagus. The NIDDK suggests the following factors:
- Those who have a bacterial infection known as Helicobacter pylori (H. pylori) seem to have a lower incidence of Barrett’s Esophagus. However, the bacteria is a main cause of stomach ulcers and can lead to stomach cancer.
- The overuse of aspirin or other anti-inflammatory drugs, however, can also lead to stomach ulcers.
- following a diet that is high in fruit, vegetables, and certain vitamins
The main cause of Barrett’s esophagus is acid reflux.
Acid reflux occurs when digestive acid or bile splashes back into the esophagus from the stomach. This can lead to inflammation and eventually GERD.
Barrett’s esophagus occurs in roughly 10 percent of people with acid reflux.
According to the NIDDK, the average age of diagnosis for Barrett’s esophagus is 55 years.
To diagnose Barrett’s esophagus, healthcare providers may recommend that people with signs of acid reflux undergo an endoscopy. This is an examination of the esophagus, stomach, and intestine carried out by inserting a small, flexible tube with a light at the end.
A physician uses endoscopy to look for specific changes in the lining the esophagus that might indicate Barrett’s esophagus.
A doctor will also use endoscopy to monitor an individual after they identify the condition. These will often occur:
- after 1 year, followed by one every 3 years if no tissue changes are found
- between 6 months and 1 year after diagnosis for people with mild tissue changes
The physician might take a tissue sample, known as a biopsy, at the same time. They will usually perform this under light sedation.
It is difficult for doctors to take a biopsy that represents the entire lining of the esophagus. Not all areas will have Barrett’s. As a result, the doctor will typically take at least eight biopsies during the procedure.
Normal tissue has a different appearance to tissue with Barrett’s. Normal tissue appears pale and glossy, while Barrett’s tissue is red and velvety.
Treatment of Barrett’s esophagus depends on how severe the tissue change is, as well as overall health.
Treatments for no or mild tissue changes involves
- medication to control GERD
- possible surgery to tighten the muscle in the stomach that stops stomach acid from escaping.
Treating GERD can slow the progression of Barrett’s esophagus by reducing the acidity of gastric juices that might come in contact with the esophagus.
Treatments for severe tissue changes
Severe or widespread tissue changes will require more interventional treatment.
- Endoscopic resection: This is the removal of abnormal cells using an endoscope.
- Radiofrequency ablation: In this procedure, the surgeon destroys abnormal tissue with radio waves that cause heat.
- Cryotherapy: The physician applies cold liquid or gas to abnormal cells in a cycle of freezing and thawing that damages Barrett’s tissue.
- Photodynamic therapy: This is the process of making abnormal cells sensitive to light with the use of a light-activated chemical called profimer. The doctor then uses a laser to destroy these cells.
- Endoscopic mucosal resection: The surgeon removes abnormal tissue using an endoscope, sometimes in combination with photodynamic therapy.
- Esophagectomy: The surgeon completely removes affected sections of the esophagus, then rebuilds those parts using sections of the stomach or small intestine.
A healthcare provider may recommend medication to treat GERD. These medications include a class of drugs known as proton pump inhibitors (PPIs).
Examples of PPIs include omeprazole, lansoprazole, and esomeprazole.
A person can also make certain lifestyle changes to reduce symptoms of GERD and the risk of Barrett’s:
- Maintain a healthy weight.
- Avoid tight-fitting clothes.
- Give up smoking.
- Avoid stooping, bending, or lying down after eating.
- Raise the head of the bed by 6 to 8 inches by placing wooden blocks underneath.
People who experience symptoms of GERD or have questions about their risk of Barrett’s should speak with their healthcare provider.