Barrett's Esophagus

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Barrett's esophagus facts

  • Barrett's esophagus is a complication of chronic (long lasting) and usually severe gastrointestinal reflux disease (GERD), but occurs in only a small percentage of patients with GERD.
  • Criteria are needed for screening patients with GERD for Barrett's esophagus. Until validated criteria are available, it seems reasonable to do screening endoscopies in GERD patients who cannot be taken off acid suppression therapy after two to three years.
  • The diagnosis of Barrett's esophagus rests upon seeing (at endoscopy) a pink esophageal lining that extends a short distance (usually less than 2.5 inches) up the esophagus from the gastroesophageal junction and finding intestinal type cells (goblet cells) on biopsy of the lining.
  • There is a small but definite increased risk of cancer of the esophagus (adenocarcinoma) in patients with Barrett's esophagus.
  • If the diagnosis of Barrett's esophagus is uncertain, a second opinion should be obtained because this diagnosis may generate greater costs than GERD alone as well as problems with obtaining life, health, and disability insurance. Therefore, it is critical to make an accurate diagnosis.
  • The treatment for Barrett's esophagus is, in general, essentially the same as for GERD. Treatment of GERD either medical (acid-suppressing drugs) or surgical (fundoplication), does not result in the disappearance of Barrett's esophagus or in a reduced cancer risk.
  • Dysplasia is a cellular process that occurs in the Barrett's lining and indicates a heightened risk of cancer. Therefore, periodic endoscopic biopsies, of the Barrett's mucosa are performed to look for dysplasia.
  • The recommended frequency for initial endoscopic biopsy surveillance in Barrett's without dysplasia is twice annually. If no dysplasia is found, surveillance then is performed every three years.
  • Endoscopic biopsy surveillance if low grade dysplasia is present should be done every six months indefinitely.
  • The management of high grade dysplasia involves repeating the biopsies soon after the high grade dysplasia is discovered to exclude an accompanying cancer. Esophagectomy (surgical removal of the esophagus) is the gold standard of therapy for high grade dysplasia and cancer, but experimental procedures are available.
  • Ablation (removal by destruction) and other experimental techniques look promising, but long term (5-year) data to prove their durability and impact on the natural history of Barrett's, dysplasia, and early cancer are awaited.
Medically Reviewed by a Doctor on 1/23/2015

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Barrett's Esophagus Symptoms

Barrett's esophagus has no unique symptoms. Patients with Barrett's have the symptoms of GERD (for example, heartburn, regurgitation, nausea, etc.). The general trend is for individuals with Barrett's have more severe GERD. However, not all Barrett's have marked symptoms of GERD, and some patients are detected accidentally with minimal or no symptoms of GERD.

  • Heartburn is a burning sensation behind the breastbone, usually in the lower half, but may extend all the way up to the throat. Sometimes, it is accompanied by burning or pain in the pit of the stomach just below where the breastbone ends.
  • Regurgitation (backup) of bitter tasting fluid is another common symptom.

The refluxed, regurgitated fluid occasionally may enter the lungs or the voice box, resulting in what are called extraesophageal symptoms of GERD. These symptoms include:

  • new onset adult asthma,
  • frequent bronchitis,
  • chronic cough,
  • sore throats, and
  • hoarseness.