Barrett’s esophagus is a condition in which the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia.
No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). Although people who do not have GERD can have Barrett’s Esophagus, the condition is found about three to five times more often in people who also have GERD. A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus.
Barrett’s esophagus affects about 1 percent of adults in North America. The average age at diagnosis is 50, but determining when the problem started is usually difficult. Men develop Barrett’s esophagus twice as often as women, and Caucasian men are affected more frequently than men of other races. Barrett’s esophagus is uncommon in children.
Barrett’s esophagus can only be diagnosed using an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. In an upper GI endoscopy, after the patient is sedated, the doctor inserts a flexible tube called an endoscope, which has a light and a miniature camera, into the esophagus. If the tissue appears suspicious, the doctor removes several small pieces using a pincher-like device that is passed through the endoscope. A pathologist examines the tissue with a microscope to determine the diagnosis.
People with Barrett’s esophagus have a low risk of developing a kind of cancer called esophageal adenocarcinoma. Less than 1 percent of people with Barrett’s esophagus develop esophageal adenocarcinoma each year. Barrett’s esophagus may be present for several years before cancer develops. Esophageal adenocarcinoma is frequently not detected until its later stages when treatments are not always effective.
Surgical removal of most of the esophagus is recommended if a person with Barrett’s esophagus is found to have severe dysplasia or cancer and can tolerate a surgical procedure. Many people with Barrett’s esophagus are older and have other medical problems that make surgery unwise; in these people, the less-invasive endoscopic treatments would be considered. Several endoscopic therapies are available to treat severe dysplasia and cancer. During these therapies, the Barrett’s lining is destroyed or the portion of the lining that has dysplasia or cancer is cut out. The goal of the treatment is to encourage normal esophageal tissue to replace the destroyed Barrett’s lining.
Since Barrett’s Esophagus is more commonly seen in people with GERD, most physicians recommend treating GERD symptoms with acid-reducing drugs. A surgical procedure may be recommended if medications are not effective in treating GERD.