The esophagus is the muscular tube that connects the oral cavity to the stomach and is typically internally lined by a layer of flat cells that appear pink. In the barret’s esophagus, the cells of this layer become tall, thick, columnar, and turn red, appearing more like the intestinal cells. This change is most commonly due to chronic GERD (gastroesophageal reflux disease). GERD occurs when the sphincter at the junction of the esophagus and stomach (lower esophageal sphincter) fails to work, and acid reflux from the stomach starts coming in contact with the esophageal lining. About 10% of people with chronic GERD have a barret’s esophagus. Barret’s esophagus can also occur in those who do not suffer from GERD.
The exact cause of barret’s esophagus is unknown, but people with chronic GERD are more likely to change, developing barret’s esophagus. In people with GERD, acids and chemicals from the stomach come in contact with the esophageal cells causing reflux esophagitis. Then these cells heal and differentiate into intestinal cells.
Barret’s esophagus can be sub-divided according to the area of the esophagus involved;
Long segment – involves 3cm or more length of the esophagus.
Short segment – less than 3cm of the esophagus is affected. Individuals with this kind have a low risk of developing cancer afterward.
The Barett’s esophagus is differentiated into types based on the type of cells present;
Non-dysplastic – if dysplasia is not present, i.e., absence of pre-cancerous cells.
Low-grade dysplasia - very early form of pre-cancerous cells.
High-grade dysplasia – advanced pre-cancerous cells.
Carcinoma - cancer cells.
About 10% of individuals with GERD and 2% of the general population are estimated to develop a barret’s esophagus. It is most commonly seen in white males and people around 40 to 60 years of age. The factors which increase the incidence of barret’s esophagus comprise;
● A family history of barret’s esophagus increases the chances of developing it.
● Barret’s esophagus is more commonly seen in males than in females.
● Aging increases the odds of getting the condition.
● Obesity is a significant risk factor.
● Smokers have a higher risk of developing Barret’s esophagus than non-smokers.
● White people are more likely to get the disease than people of any other race.
● Caucasians are at higher risk as well.
The change in cells does not cause any symptoms, but the usual characteristics associated with the barret’s esophagus are;
● Dysphagia or trouble swallowing solid foods.
● Chest pain
● Burning sensation in the throat
● Passing blood stools
If you are suspected of having a barret’s esophagus, your doctor will either order an upper gastrointestinal endoscopy or, to finally come to a conclusion, a biopsy may be ordered.
Endoscopy is a testing procedure in which a tiny camera attached to a long tube is inserted into your body through the mouth. It helps the doctor to see and examine the inside of the body. When barret’s esophagus is viewed with an endoscopy, abnormal red tissue having acid reflux damage can be seen.
A biopsy is a procedure used to remove tissues and cells from inside your body. These tissues are taken to the laboratory to check for changes. A tissue sample is taken from the esophagus during the test with the same endoscope. It is then checked for the presence of differentiation of cells to abnormal or dysplastic cells.
The following disorders can be considered as the differential diagnosis for barret’s esophagus;
● Esophageal carcinoma.
● Gastroesophageal reflux disease
● Peptic ulcer disease
● Esophageal motor disorders
● Cardiac intestinal metaplasia.
Treatment for barret’s esophagus varies for different stages of the condition.
If you are diagnosed without any dysplastic cells but have symptoms of GERD, your doctor will treat the GERD by prescribing medications that decrease stomach acidity. So, your esophagus is relieved from any more damage. You will also be advised to get monitored every two to three years for any pre-cancerous cells.
Barret’s esophagus with pre-cancerous cells means you have abnormal cells. You are given medications that prevent cancer and are monitored every six months to a year.
If high-grade dysplasia is detected, cancer is more likely to occur. You will be monitored more frequently and may undergo procedures that are discussed later.
To treat GERD symptoms, acid-suppressing medicines are used, which are also known as proton-pump inhibitors. These will help heal the damage caused to the esophagus. The proton-pump inhibitors include;
Histamine blockers are also used to lower acid secretion.
The doctor will suggest certain procedures, which are:
Periodic surveillance endoscopy
It is done over time to check cellular changes and cancer development.
Endoscopic ablative therapies
These are used to remove the dysplastic tissue detected. They include photodynamic therapy, radiofrequency ablation,
Endoscopic mucosal resection
In this procedure, the doctor lifts the abnormal tissue, injects a solution beneath it, and removes the tissue.
It is the procedure in which extreme cold is used in the form of liquid nitrogen onto the abnormal cells, and it causes the cells to freeze and die.
Having barret’s esophagus increases your risk of having esophageal cancer by about ten times higher. Although over 90% of patients with barret’s esophagus don’t develop cancer, it is considered a pre-cancerous condition.
The symptoms of the barret’s esophagus can be improved by making the following life changes;
● Eat smaller meals
● Avoid spicy foods
● Consume less saturated fat
● Don’t lie down after having a meal
● Avoid foods that trigger heartburn, such as carbonated drinks and tomato sauce.
● Quit smoking
● Maintain a healthy weight
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 12, 2023.