Barrett's Esophagus

Barrett's esophagus is a peptic ulcer of the lower esophagus caused by cells that normally stay in the stomach lining.  Since the stomach cells are used to contact with acids, their growth into the esophagus may actually be a defense mechanism to protect the normal tissue in the esophagus against further damage by heartburn reflux.  This may explain why the symptoms of heartburn seem to lessen in some patients with Barrett’s esophagus.  In time, however, the Barrett’s cells in some patients may change in the size, appearance, or growth of cells, known as dysplasia.  Over a period of years, dysplasia may worsen and develop into cancer. Doctors believe this may proceed to esophageal cancer.

Other questions that you may have about Barrett's esophagus include:

Who gets Barrett’s esophagus?

Usually, Barrett’s esophagus starts as a result of chronic heartburn.  It tends to be found three times more often in males than in females.  In some instances, it may be present at birth.

What does it feel like?

Heartburn, also called acid indigestion, is the most common symptom of GERD, and usually feels like a burning chest pain that starts behind the breastbone and moves upward to the neck and throat. Many people say it feels like food is coming back into the mouth leaving an acid or bitter taste.

The burning, pressure, or pain of heartburn can last as long as 2 hours and is often worse after eating. Lying down or bending over can also result in heartburn. Many people get relief by standing upright or by taking an antacid that clears acid out of the esophagus.

Heartburn pain can feel like the pain patients have with heart disease or a heart attack, but they are not the same. Exercise may increase pain resulting from heart disease, and rest may relieve the pain. Heartburn pain is less likely to happen along with physical activity.

How do I know if I have Barrett’s esophagus?

Diagnosis of Barrett’s esophagus requires an endoscopic procedure.  By placing a small lighted tube with a tiny video camera on the end (endoscope) into the esophagus, the doctor may see reddened or inflamed tissue lining of the esophagus.  Small samples of tissue, called biopsies, are removed from the lining of the esophagus.  The biopsies are looked at under a microscope for dysplasia.  If there is dysplasia, then more exams may be performed.

How is it treated?

There is no current treatment to reverse Barrett’s esophagus, but, it appears that treating the heartburn may slow progress of the disease and prevent more problems.  Doctors recommend lifestyle and diet changes for most people with GERD. Avoiding foods and beverages that can irritate a damaged esophageal lining, such as chocolate, peppermint, fatty foods, coffee, alcohol, citrus fruits and juices, tomato products, and pepper.  Smaller portions at mealtime may also help control symptoms. Eating meals at least 2 to 3 hours before bedtime may lessen stomach acid. Also, being overweight often worsens symptoms. Many overweight people find relief when they lose weight. Cigarette smoking weakens the lower esophageal sphincter, which helps prevent reflux. Therefore, stopping smoking reduces symptoms. Placing the head of the bed on 6-inch blocks or sleeping on a special wedge pillow reduces heartburn by letting gravity decrease reflux of stomach acid into the esophagus.

For chronic reflux and heartburn, the doctor may prescribe medications to reduce acid in the stomach.  These drugs are almost always needed to treat severe heartburn.  Other medications can strengthen the lower esophageal sphincter.

Does Barrett’s esophagus require surgery?

A small number of people with Barrett’s esophagus may need surgery because of severe reflux and poor response to treatment. Fundoplication is a surgery that increases pressure in the lower esophagus. It is often done by laparoscope.  Laparoscopy is not very invasive and is performed with a tiny cut at the naval and a few needle points in the upper abdomen.  The patient often returns home in 1-2 days.

If esophageal cancer occurs, more surgery to remove cancer tissue is needed.

What can I expect long term?

While there is no treatment to reverse Barrett’s esophagus, the likelihood of developing cancer and other problems can be reduced with diet, lifestyle changes, medication, and/or surgery.  Barrett’s esophagus requires regular monitoring by your doctor.  The doctor must perform regular endoscopy exams and biopsies to look for dysplasia.  How often these exams are repeated depends on how far the disease has advanced.  By working closely with your doctor, you can expect good control of heartburn and Barrett’s esophagus.