Barrett’s Esophagus: Causes, Symptoms, and Treatment

In Barrett’s esophagus, the tissue lining the esophagus undergoes a transformation known as intestinal metaplasia. This process replaces the normal, squamous tissue with a type of tissue more commonly found in the intestines. Experts believe this change occurs as a protective mechanism against the persistent acid exposure caused by gastroesophageal reflux disease (GERD). While Barrett’s esophagus itself is not cancerous, these cellular changes significantly increase the risk of developing esophageal cancer if left untreated.

Chronic GERD (gastroesophageal reflux disease) is the leading cause of Barrett’s esophagus. Prolonged acid reflux irritates the esophageal lining, leading to persistent inflammation and cellular changes that increase the risk of developing this condition. Several factors can worsen GERD, including obesity, smoking, secondhand smoke exposure, and certain dietary habits.

Some medications, such as asthma treatments, calcium channel blockers, and NSAIDs, may also contribute to GERD symptoms. Additionally, a hiatal hernia—a condition where part of the stomach pushes into the chest through the diaphragm—can make GERD more severe and increase the likelihood of complications like Barrett’s esophagus.

Certain groups are more likely to develop Barrett’s esophagus, with the highest risk seen in men, non-Hispanic whites, and individuals over age 50. Smoking and obesity are also significant risk factors, as both can aggravate acid reflux, a key contributor to the condition. A family history of Barrett’s esophagus or esophageal cancer further increases susceptibility. For those with at least three risk factors, screening with an endoscopy is strongly recommended to catch potential changes early. While women are generally less likely to develop Barrett’s esophagus, those with uncontrolled reflux or other concerning symptoms should still consider screening to address potential risks.

Barrett's esophagus does not have any symptoms on its own, but people who have it may exhibit symptoms of GERD. These can include heartburn that worsens after meals or when lying down, difficulty swallowing, chest pain, nausea, or chronic cough.

That said, about half of people diagnosed with Barrett's esophagus report little or no symptoms of acid reflux. People who experience trouble swallowing, unexplained weight loss, persistent vomiting, or signs of bleeding should see their doctor.

Barrett's esophagus is diagnosed with an upper endoscopy. In this procedure, the doctor uses a flexible tube with a camera called an endoscope to assess the lining of the esophagus, stomach, and duodenum. The doctor can collect tissue samples for biopsy during the procedure if needed. A pathologist will examine this tissue under a microscope and look for abnormal cell growth, which can indicate a risk of cancer.

Proton-pump inhibitors are the primary treatment for people with Barrett's esophagus, regardless of whether they have reflux symptoms. For people with reflux symptoms, avoiding trigger foods, losing weight, and quitting smoking can also help manage symptoms.

If tissue changes are found, there are several treatment options available.

• Radiofrequency ablation: Radiofrequency ablation is a minimally invasive medical procedure that uses radio waves to destroy abnormal tissue.
• Cryotherapy: Cryotherapy uses extreme cold to freeze and destroy abnormal tissue.
• Endoscopic mucosal resection: Doctors use an endoscope and other tools to locate abnormal tissue and remove it.

Monitoring and early detection are key to managing Barrett’s esophagus and preventing complications. Regular endoscopies help identify precancerous changes (dysplasia) early, allowing for timely treatment.

• No Cellular Changes: If no abnormalities are found, rescreening is advised every three to five years.
• Minor Abnormalities (Without Dysplasia): A proton pump inhibitor may be prescribed, with a follow-up endoscopy in six months. If no changes occur, annual screenings are recommended.
• Low-Grade Dysplasia: Ablative therapies such as radiofrequency ablation, cryotherapy, or endoscopic mucosal resection are often recommended. For those unable to undergo therapy, endoscopies should be repeated every six months, transitioning to annual checks if no progression is detected.
• High-Grade Dysplasia: More frequent follow-ups are required after treatment, with screenings at three, six, and 12 months. Annual screenings can resume if no recurrence is found.

Barrett's esophagus may not have any symptoms, and those symptoms that may occur are generally related to GERD, which can make it difficult to understand when to see a doctor. If you have experienced heartburn, acid reflux, or regurgitation for more than five years, talk to your doctor about your risk and whether a screening endoscopy is appropriate.

Symptoms such as difficulty swallowing, chest pain, unintentional weight loss, vomiting blood (red or resembling coffee grounds), or passing bloody or black stools should be promptly evaluated by a healthcare provider.

Barrett's esophagus may not always have symptoms, making early detection and consistent monitoring critical for people with this condition. Although Barrett's esophagus can increase the risk of esophageal cancer, lifestyle changes and medication to control GERD and regular checkups and screening can help effectively manage your risks.