Barrett’s Esophagus

Background Information:

Gastroesophageal reflux disease (GERD) is a clinical condition in which contents normally found within the stomach regurgitate, i.e., reflux back into the esophagus –  the tube that connects the mouth to the stomach. Symptoms associated with reflux include heartburn, chest pain, and/or regurgitation of acid. Almost all adults reflux at one time or another, often after a big meal or at night. If unchecked, reflux can cause an ulcer, a stricture (abnormal narrowing of the esophagus), or a change in the lining cells of the esophagus (Barrett’s esophagus).

It is estimated that Barrett’s esophagus affects about 700,000 adults in the United States at any given time. While Barrett’s esophagus may cause no symptoms itself, it is a serious condition that is associated with an increased risk of cancer. Accordingly, the American College of Gastroenterology recommends that patients with symptoms of GERD undergo an endoscopy to detect the possible existence of Barrett’s esophagus.

Testing:

Upper Endoscopy is the standard procedure for diagnosing GERD or Barrett’s esophagus.  A gastroenterologist uses a tube-like device to examine the lining of the esophagus for changes that may indicate reflux or Barrett’s esophagus. Small tissue samples (biopsies) may be taken through the endoscope for microscopic examination by a surgical pathologist – a physician who specializes in the diagnosis of disease via microscopic examination of a tissue sample. The pathologist will determine if 1) reflux-induced changes are evident, 2) Barrett’s esophagus has developed, or 3) if dysplasia (pre-cancer) or actual cancer is present.

Treatment Options and Follow-up for Barrett’s Esophagus:

The treatment of Barrett’s esophagus is very similar to the treatment of GERD and may include 1) lifestyle changes to avoid the consumption of late-night meals and foods that contribute to the onslaught of problematic symptoms, and 2) the taking of prescription medication(s) to reduce acid. These medications, call proton pump inhibitors, are usually a lot stronger than over-the-counter antiacids.
  • Medical Treatment for Reflux:
    • Patients with reflux are often treated with one of a family of prescription medications – called proton pump inhibitors – designed to reduce gastric acid.
    • Proton pump inhibitors are considerably stronger than over-the-counter antacids.
  •  Surgical Treatment for Reflux:
    • Patients afflicted with severe reflux disease may be referred for antireflux surgery, e.g., laparoscopic fundoplication.
  • Follow-up Endoscopy for Barrett’s Esophagus:
    • The American College of Gastroenterology believes that systematic biopsies of the involved esophagus are required to document Barrett’s esophagus and to detect the existence of dysplasia or cancer, if present. The grade of dysplasia, determined by the surgical pathologist, dictates the follow-up interval, as indicated in the following table:

Status of Dysplasia

Follow-up Endoscopy
None1  In two-to-three years 
Low-grade  In six months to one year 
High-grade (focal)  Immediately and every three months thereafter, with biopsy 
High-grade (extensive)  Immediately, with biopsy and intervention2 

1 After two negative annual examinations
2 Intervention options include surgery, laser ablation, photodynamic therapy, endoscopic mucosal resection, etc.

Measures You Can Take to Reduce the Symptoms of Gastroesophageal Reflux:

  • Avoid large meals within three hours of bedtime.
  • Avoid the consumption of caffeine, chocolate, or alcohol
  • Elevate the head of your bed.
  • Use throat lozenges or chewing gum to stimulate salivation.
  • Maintain a high-fiber diet that is low in fat and calories
  • Consult your physician for proper diet and nutrition information

Important Questions to Ask Your Doctor: 

  • Do I have Barrett’s esophagus?
  • What is my risk of getting cancer?
  • What can I do to take care of myself during and after treatment?
  • Will I require any additional monitoring if I take my medication?

Sources of Additional Information:
American College of Gastroenterology : acg.gi.org

American Gastroenterological Association : gastro.org

This Patient Diagnostic Fact Sheet is provided to you as a service by AmeriPath. It is intended for patient education and information only. It does not constitute advice nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon your medical history and current condition. Only your physician and you can determine your best treatment options.