Barrett's esophagus

Precancerous conditions of the esophagus are changes to esophagus cells that make them more likely to develop into cancer. These conditions are not yet cancer. But if they aren't treated, there is a chance that these abnormal changes may become esophageal cancer.

Barrett's esophagus is the most common precancerous condition of the esophagus. In Barrett's esophagus, the normal cells lining the esophagus are replaced by cells that are like the lining of the stomach or intestine. This is called intestinal metaplasia. It is most often found in the gastroesophageal (GE) junction, which is where the esophagus joins the stomach.

People with Barrett's esophagus have a higher risk of developing abnormal cells, called dysplasia. Dysplasia describes how abnormal cells look. With low-grade dysplasia, the abnormal cells look somewhat different from normal cells. In high-grade dysplasia, the cells look very abnormal.

Dysplasia increases the risk of developing esophageal cancer. High-grade dysplasia increases the risk more than low-grade dysplasia or metaplasia.

Risk factors

The main risk factor for developing Barrett's esophagus is gastroesophageal reflux disease (GERD). But not everyone with GERD will develop Barret esophagus, and not everyone with Barrett's esophagus will develop cancer.

Other risk factors for Barrett's esophagus include obesity, smoking and drinking alcohol.

Symptoms

The symptoms of Barrett's esophagus may include:

  • stomach acid moving up into the esophagus (acid reflux)
  • heartburn
  • indigestion
  • chronic cough
  • hoarseness
  • having frequent lung infections (pneumonia)
  • back up of stomach contents into the mouth (regurgitation)
  • nausea and vomiting
  • changes to the teeth caused by regurgitation

Diagnosis

If you have symptoms or your doctor thinks you might have Barrett’s esophagus, you will be sent for tests. Tests used to diagnose Barrett’s esophagus may include:

  • upper gastrointestinal (GI) endoscopy
  • biopsy
  • endoscopic ultrasound (EUS)

Treatments

Treatments for Barrett’s esophagus may include:

Medicines such as proton pump inhibitors or H2 blockers may be given to treat GERD. These medicines control the amount of acid made in the stomach and reduce acid reflux.

Endoscopic mucosal resection (EMR) may be used to treat high-grade dysplasia in the esophagus. EMR removes the inner lining of the esophagus where there are abnormal cells.

Radiofrequency ablation (RFA) uses a high-frequency electrical current to remove abnormal cells. A balloon is connected to the end of an endoscope. The endoscope is inserted into the esophagus and the balloon is inflated so that the balloon can cover the area of abnormal cells. The radiofrequency current is given through the wall of the balloon.

Photodynamic therapy (PDT) uses a drug that makes cells sensitive to light. The drug is given intravenously, and the abnormal cells take it up from the blood stream. Using an endoscope inserted into the esophagus, the doctor exposes the abnormal cells to a light to destroy them.

Surgery to remove all or part of the esophagus is called an esophagectomy. It may be used to treat high-grade dysplasia in Barrett's esophagus, if there are very large or many areas of dysplasia. You must be healthy enough to have surgery.

Expert review and references

  • Abraham SC, Wu T . Esophageal Cancer: Pathology. Kelsen, D. P., Daly, J. M., Kern, S. E., Levin, B., Tepper, J. E., & Van Cutsem, E. (eds.). Principles and Practice of Gastrointestinal Oncology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 16: 179-191.
  • American Cancer Society. Esophagus Cancer. Atlanta, GA: American Cancer Society; 2013.
  • Cancer Research UK. Barrett's oesophagus. Cancer Research UK; 2014.
  • Dellon ES & Shaheen NJ . Esophageal cancer: epidemiology, screening, and prevention. Kelsen, D. P., Daly, J. M., Kern, S. E., Levin, B., Tepper, J. E., & Van Cutsem, E. (eds.). Principles and Practice of Gastrointestinal Oncology. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 14: pp. 157-165.
  • Hart J . Barrett's esophagus with high-grade dysplasia and/or esophageal adenocarcinoma. Posner, M. C., Vokes, E. E. & Weichselbaum, R. R. Cancer of the Upper Gastrointestinal Tract. Hamilton: BC Decker Inc.; 2002: 4: 67-84.
  • Johnston, M. H. et al . Barrett esophagus. eMedicine.com. Omaha: eMedicine, Inc; 2014.
  • Longstreth GF . Anti-reflux surgery. National Cancer Institute & National Library of Medicine. MedlinePlus: Trusted Health Information For You: Medical Encyclopedia. Bethesda, MD: National Cancer Institute & National Library of Medicine; 2009.
  • Barrett's oesophagus. Macmillan Cancer Support. Macmillan Cancer Support. London, UK: Macmillan Cancer Support; 2013.
  • National Cancer Institute. Esophageal Cancer Treatment (PDQ®) Patient Version. Bethesda, MD: National Cancer Institute; 2013.
  • National Cancer Institute. Esophageal Cancer Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • Barrett's esophagus. National Cancer Institute & National Library of Medicine. MedlinePlus: Trusted Health Information For You: Medical Encyclopedia. Bethesda, MD: National Cancer Institute & National Library of Medicine; 2013.