Symptoms, Causes, Treatment & More

Barrett’s esophagus occurs when the lining of the esophagus, the tube that runs from the throat to the stomach, is inflamed.

Up to 1.6% of the general population have Barrett’s esophagus. It is often associated with gastroesophageal reflux disease (GERD), as 5-15% of people with GERD develop Barrett’s esophagus.

Treatment options depend on how severe your case is; there are many ways to treat and prevent it.

Barrett’s esophagus does not always cause symptoms; many live with it without experiencing signs. When there are symptoms, they occur due to GERD and stomach acid exposure. Individual cases vary, but common signs include:

• Heartburn: This condition is a painful burning sensation in the middle of your chest, often rising from your stomach.
• Regurgitation: Stomach acids and undigested foods can flow back up your esophagus and into your throat and mouth, causing an acidic or sour taste.
• Chest pain: Severe heartburn can also cause sharp, stabbing pains in your chest, which can be mistaken for a heart attack.
• Nausea: Feeling sick or wanting to throw up can accompany GERD and Barrett’s esophagus.
• Dysphagia: Dysphagia is the medical term for difficulty or pain while swallowing; it may also cause trouble eating and loss of appetite.
• Respiratory problems: Regurgitated stomach acids that reach the back of your throat can be inhaled and cause irritation in your lungs and airways. This effect can also cause a hoarse voice and chronic cough, among other symptoms.

Your esophagus is a tube that runs from the pharynx (back of your throat) to the top of your stomach. In Barrett’s esophagus, cells lining your esophagus, called squamous epithelial cells, undergo changes that make them more like the intestinal lining. This inflammatory response turns them into columnar cells, resulting in columnar metaplasia. Barrett’s esophagus is a type of columnar metaplasia.

Researchers are not sure why this happens but have linked it to exposure to stomach acids from GERD. This occurs when your lower esophageal sphincter (LES)—the muscular ring at the bottom of your esophagus—does not close properly, allowing your stomach contents to flow back up.

Risk Factors

People who are non-Hispanic white, those who were assigned male at birth, and people over age 55 are more likely to experience Barrett’s esophagus. Certain diseases and health factors also raise your risk, including:

• Smoking tobacco
• Experiencing acid reflux for an extended period (10-plus years)
• Pregnancy
• Hiatal hernia, when part of your stomach pushes into your chest cavity through your diaphragm
• Obesity, or excess weight (a body mass index of 30 or more)
• Asthma, which causes bouts of breathing difficulties
• Diabetes, an inability to properly produce and use insulin
• Peptic ulcer disease, the development of sores on the inside of your stomach
• Connective tissue disorders, which affect tissues in your body, such as scleroderma

If your healthcare provider suspects Barrett’s esophagus, they will work to rule out other conditions that can cause symptoms. These include gastritis (inflammation of the stomach lining), esophageal cancer, and esophagitis (swollen esophagus).

In addition to taking your medical history, your healthcare provider may perform the following diagnostic tests:

• Upper gastrointestinal (GI) endoscopy: This involves using an endoscope (an adjustable tube with a camera) to check the lining of your esophagus and stomach for signs of inflammation.
• Biopsy: During an upper GI endoscopy, your healthcare provider collects a tissue sample from your esophagus to test for cancer or infection.
• Esophageal pH monitoring: Your healthcare provider inserts a catheter (a thin tube) through your nose or places a Bravo pH monitoring test (a small wireless capsule) in your esophagus to measure acid levels caused by GERD.

The treatment of Barrett’s esophagus depends on symptom severity and underlying cause. If the condition is not causing problems, your provider may recommend regular monitoring with endoscopy due to the risk of the tissues becoming cancerous.

Treatments to manage and prevent GERD can help prevent the condition from getting worse. Surgery or other therapies can also remove damaged or precancerous tissue.

Medications

Over-the-counter (OTC) and prescription medications called proton-pump inhibitors (PPIs) can help treat and manage Barrett’s esophagus. Common PPIs include Nexium 24HR (esomeprazole), Prevacid 24HR (lansoprazole), and Prilosec OTC (omeprazole).

Other OTC medications can help ease acid reflux and heartburn symptoms. These include antacids, such as Tums or Alka-Seltzer (calcium carbonate), and H2 inhibitors, including Tagamet HB (cimetidine), Pepcid AC (famotidine), and Axid (nizatidine).

Endoscopic Ablation

Endoscopic ablation is performed if your healthcare provider thinks your Barrett’s esophagus is progressing to esophageal cancer.

During this medical procedure, a doctor, usually a gastroenterologist (a doctor specialized in digestive issues) or surgeon, destroys irregular tissue that may be cancerous or dysplasia (precancerous) from your esophagus. After the procedure, your body should begin to make normal esophageal cells.

Radiofrequency ablation involves using an endoscope to apply directed radio waves to burn away abnormal tissue. Another option is photodynamic therapy or lasers to remove dysplasia.

Surgeries

Surgery may be performed in cases where cancer is likely present or there is a high risk of cancer developing.

Endoscopic mucosal resection (EMR) is a surgery that may be used in cases of significant dysplasia or cancer. It is minimally invasive and involves suctioning or injecting a solution to prepare tissue to cut away.

Esophagectomy is used to remove cancerous tissue from the esophagus. During the surgery, your surgeon removes abnormal tissue, replacing it with healthy tissue from your stomach or large intestine.

Preventing Barrett’s esophagus means preventing GERD and associated acid reflux. Lifestyle changes, including a diet adjustment, can go a long way in preventing symptoms and slowing progression. Several strategies may help:

• Avoid smoking
• Sleep with pillows or wedges to elevate your head about 6-8 inches
• Avoid alcohol or caffeinated beverages
• Steer clear of acidic foods (tomatoes and citrus), chocolate, mint, or spicy or high-fat foods
• Maintain a healthy weight
• Regularly screen for signs of cancer

Barrett’s esophagus is not fatal, but left untreated, this condition and chronic GERD can further affect cells, leading to esophageal adenocarcinoma. Though it only represents 1% of all cancer cases, those with Barrett’s esophagus are 11 times as likely to develop this type of cancer as those without the condition.

Esophageal cancer usually does not cause symptoms in the early stages, which means it is often not caught until advanced stages when it is more difficult to treat. Typical signs of this condition include:

• Difficulty swallowing
• Burning or pain in your chest
• Coughing
• Hoarse voice
• Unexplained weight loss
• Worsening heartburn and regurgitation symptoms

Barrett’s esophagus occurs when the tissues lining your esophagus become abnormal and inflamed. This condition may or may not cause symptoms.

Regurgitation (stomach contents coming back up) and heartburn are among the primary signs of acid reflux, which can lead to Barrett’s esophagus over time.

Treatments for this condition include OTC or prescribed medications, surveillance, and medical procedures or surgeries to remove precancerous tissue.