Barrett’s Esophagus

What is Barrett’s esophagus?

Barrett’s esophagus is a change in the lining of the esophagus. (The esophagus is the tube that carries food from the mouth to the stomach.) The change makes the esophagus lining more like the lining of the intestines.

How does it occur?

Usually Barrett’s esophagus results from stomach acid that flows backward into the esophagus. This is called GER, or gastroesophageal reflux.

Everyone has reflux once in a while. Reflux usually happens after eating, especially after eating spicy foods, or from bending over soon after eating. It’s also called heartburn or acid indigestion. If you have GER more than twice every week, it can develop into gastroesophageal reflux disease (GERD). GERD can cause or worsen other problems, such as ulcers, asthma, and Barrett’s esophagus.

Although reflux usually causes heartburn symptoms, Barrett’s esophagus in the early stages does not cause symptoms. However, over time the lining of the lower esophagus may begin to change. The changed tissue can become cancer. Fortunately, this happens slowly. If it is found early, before it has become cancer, it can be treated to keep it from becoming cancer.

Barrett’s esophagus is a common problem in adults. It is usually diagnosed in midlife, around the age of 50. It is twice as common in men as women. It’s more common among Caucasians. Of the people who have Barrett’s esophagus, fewer than 1% will develop cancer of the esophagus.

What are the symptoms?

Until it is severe, Barrett’s esophagus has no symptoms. However, it is often preceded by years of reflux. Symptoms of reflux include:

• acid or sour taste in the mouth
• belching of acid
• heartburn (a burning pain in the chest, which can sometimes be confused with heart pain, especially in women)
• frequent unexplained cough
• wheezing, shortness of breath, and chest tightness (symptoms of asthma).

A severe case of Barrett’s esophagus can cause irritation, bleeding, and scarring in the esophagus. At this stage it can cause symptoms, including:

• trouble swallowing
• food getting stuck in the esophagus
• weight loss.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and examine you. If your provider thinks you might have Barrett’s esophagus, you will have an upper endoscopy. For this exam you are given medicine to relax you. Then your provider inserts a slim, lighted, flexible tube with a tiny camera into your esophagus. Samples of any areas that look abnormal are removed (biopsied) for testing. The tests can detect Barrett’s esophagus. They can also check for cancer or any precancerous changes in the lining of the esophagus.

How is it treated?

The goal of treatment is to control reflux and keep the esophagus lining from becoming cancerous. Treatment for Barrett’s esophagus includes:

• treatment of reflux symptoms, if you have them
• endoscopic exams on a regular schedule to check for precancerous changes.

Treatments for reflux include:

• antacids (liquid or tablet)
• medicines that decrease acid production, such as
  • cimetidine (Tagamet)
  • ranitidine (Zantac)
  • esomeprazole (Nexium)
  • omeprazole (Prilosec, Zegerid)
  • lansoprazole (Prevacid).

You will have regular checkups of your esophagus. How often you need endoscopy will depend on how much the lining of your esophagus has been affected. If there are precancerous changes, the abnormal tissue will be removed. The tissue may be removed by:

• cutting the abnormal tissue away with tiny tools through an endoscope
• destroying the tissue with a laser passed through the endoscope.

If the tissue is severely abnormal or has become cancer, then surgery is usually needed to remove the cancerous part of the esophagus. If a section of the esophagus must be removed, the remaining part of the esophagus is connected to the stomach.

How long will the effects last?

If Barrett’s esophagus is not treated, it can in some cases develop into cancer of the esophagus. Cancer of the esophagus may be prevented if Barrett’s esophagus is found and treated early and followed up with regularly scheduled exams.

How can I take care of myself?

To help keep Barrett’s esophagus from becoming cancer, follow your healthcare provider’s recommendations. This includes:

• taking medicines to decrease acid reflux
• avoiding some foods and drinks
• keeping all checkup appointments, including endoscopy exams

Things you can do to help keep acid reflux from getting worse are:

• Keep a healthy weight.
• Stop eating before you feel full.
• Raise the head of your bed to keep your head higher than your stomach when you sleep.
• Do not smoke.
• Do not drink a lot of alcohol.
• Do not wear clothing that is tight around the waist.
• Avoid bending over after meals.
• Avoid vigorous activity after meals.

See your healthcare provider if:

• You keep having reflux symptoms in spite of your current treatment.
• You have trouble swallowing.
• Food seems to be getting stuck in the esophagus.
• You have bloody vomit.
• You are losing weight without meaning to.