Barrett's Esophagus

Barrett's Esophagus Is Difficult to Diagnose

Barrett's esophagus illustration
Barrett's esophagus illustration. SHUBHANGI GANESHRAO KENE/Getty Images

What is Barrett's Esophagus?

Barrett's esophagus is a rare condition in which the lining of the esophagus is replaced by intestinal-type tissue. The replacement of your normal esophageal cells is thought to occur as a result of chronic exposure to refluxed gastric contents from gastroesophageal reflux disease (GERD). As the acid damages the normal cells of your esophagus, you can become susceptible to growing a different type of cell that is referred to as columnar epithelium.

This cell type was first identified in the esophagus by Norman Barrett, an Australian surgeon, in 1950. Barrett's esophagus can be a precursor to esophageal cancer and  does not have any distinguishable symptoms; therefore it is difficult to diagnose. Since it occurs more often in patients already diagnosed with GERD, physicians recommend that certain individuals who have been diagnosed with GERD undergo an esophagogastroduodenoscopy (EGD) to screen for Barrett's esophagus.

Prevalence and Diagnosis of Barrett's Esophagus

If you have episodes of heartburn at least once a week, you only stand about a 5% chance of developing Barrett's esophagus. However the amount of heartburn episodes you have does not increase your risk of having Barrett's esophagus. Diagnosing Barrett's esophagus can only be done by endoscopy using a two-step identification process. First, the physician performing the endoscopy will determine whether or not there is columnar epithelial cells at the distal (bottom) portion of your esophagus, close to the stomach.

If identified, the second step is to take a biopsy of the area to see if the cells have signs that they changed from one cell-type to another.

Even though the disease itself has no symptoms, about 1% of patients with Barrett's esophagus develop a dangerous form of esophageal cancer called adenocarcinoma.

For this reason, you should be monitored for dysplasia (an abnormal change in cells that can be a precursor to cancer) through endoscopy and further tissue biopsies if you are diagnosed with Barrett's esophagus.

Treating Barrett's Esophagus

If dysplasia is detected in your esophagus, the cells can be destroyed using surgery or endoscopic procedures. One treatment for Barrett's esophagus is called photodynamic therapy (PDT). This therapy uses a chemical called Photofrin, which makes tissue more sensitive to light. Forty-eight hours after Photofrin is given to the patient, a physician can pass a laser tube (via an endoscope) into the esophagus and destroy the abnormal Barrett's tissue.

Barrx, another method of destroying high-grade dysplasia, may be used if your doctor does not feel that you are a good surgical candidates. This techniques uses a Barrx catheter that is inserted into the endoscope and allows for radiofrequency ablation (destruction) of the abnormal tissue. This is a less invasive non-surgical method for destroying the Barrett's tissue in your esophagus.

Another treatment for dysplasia in Barrett's esophagus is called endoscopic mucosal resection (EMR). EMR can be used for Barrett's esophagus or for esophageal cancer. In this procedure, a substance is injected beneath the lining of the Barrett's tissue before it is removed via endoscope. If the treatment is used for esophageal cancer, only the top layer of cells will be removed. Because of this, it can only be used for severe dysplasia or very early stage cancer.

For individuals who have severe dysplasia or overt cancer and are healthy enough to undergo general anesthesia, surgery remains the first choice therapy for Barrett's esophagus with high-grade dysplasia or cancer. Several surgical procedures are used depending on a patient's individual needs and the location of the tumor.

Although Barrett's esophagus is a fairly rare disorder and there is a very small chance of developing esophageal cancer from it, adenocarcinoma of the esophagus has a relatively poor overall prognosis when diagnosed in an advanced stage. For this reason, it is important that if you are suffering from GERD, you take appropriate care with anti-reflux medications like Prilosec or Dexilant. If you are diagnosed with Barrett's esophagus, make sure to find a good ENT or gastroenterologist helping you manage your follow-up and treatments.


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National Digestive Disease Clearing House. Barrett's Esophagus. Accessed: July 30, 2016 from

Spechler, SJ & Souza, RF. (2016). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Accessed: July 30, 2016 from (Subscription Required)

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