Barrett's esophagus is a condition in which normal cells that line the esophagus, called squamous cells, turn into cells not usually found in humans, called specialized columnar cells. This process is called intestinal metaplasia because the specialized columnar cells are similar to the lining of the intestine. Damage to the lining of the esophagus causes the cells to change. Less than 1 percent of people with this condition develop cancer of the esophagus. However, having Barrett's esophagus may increase the risk of developing esophageal cancer.
Barrett's esophagus develops in some people who have chronic gastroesophageal reflux disease (GERD) or esophagitis (inflammation of the esophagus). It is believed that damage to the lining of the esophagus, caused by these conditions, causes these abnormal cell changes.
People who have had long-standing heartburn are at risk for Barrett's esophagus and should discuss this with their doctor.
The following are the most common symptoms of Barrett's esophagus. However, each individual may experience symptoms differently. Symptoms may include:
Waking in the night because of heartburn pain
Difficulty in swallowing
Blood in vomit or stool
Some people with this condition may be asymptomatic. The symptoms of Barrett's esophagus may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
In addition to physical examination, the doctor will perform an endoscopy, during which a long, thin tube, called an endoscope, is inserted through the mouth and gently guided into the esophagus. This contains instruments that allow the doctor to see the lining of the esophagus and remove a small tissue sample (a biopsy), which is examined in a laboratory to determine whether the normal squamous cells have been replaced with columnar cells. If a person complains of trouble swallowing, an upper GI barium study may be helpful in identifying areas of narrowing called strictures.
Specific treatment for Barrett's esophagus will be determined by your doctor based on:
Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of this disease
Your opinion or preference
Currently, there is no cure for Barrett's esophagus. Once the cells in the esophageal lining have been replaced by columnar cells, they will not revert back to normal. Thus, treatment is aimed at preventing further damage from occurring by stopping acid reflux from the stomach. Treatment may include:
Medication. Medications such as H2 receptor antagonists and proton pump inhibitors, which reduce the amount of acid produced in the stomach, may be prescribed by your doctor.
Surgery. Surgery to remove damaged tissue or a section of the esophagus may be necessary. Known as fundoplication, part of the esophagus is removed and the remaining section is attached to the stomach.
Dilation procedure. If strictures (narrowing of the esophagus) are present, caused when the damaged lining of the esophagus becomes thick and hardened, a procedure called dilation is used. During dilation, an instrument gently stretches the strictures and expands the opening of the esophagus.
The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.
Physicians can help stem the rising incidence of gastroesophageal cancers by aggressively treating patients with gastroesophageal reflux (GERD) and Barrett's esophagus.
David Rattner, MD, chief of the Division of Gastrointestinal and General Surgery at the Mass General Digestive Healthcare Center, answers frequently asked questions (FAQ) about the LINX® Reflux Management System, a new treatment option for gastroesophageal reflux disease (GERD).
The New England Journal of Medicine publishes the three-year results of a study of the safety and effectiveness of a new device for treatment of gastroesophageal reflux disease (GERD).
Confronting the Epidemic of Esophageal Cancer: Innovative Screening Techniques and Treatment Strategies for Barrett's Esophagus and GERD
David Ryan, MD, explains the reasons for the current epidemic of esophageal cancer.
David Rattner, MD, explains the management of gastroesophageal reflux, including indications for medical, endoscopy and surgical interventions to control this condition.
Christopher Morse, MD, reviews minimally invasive treatments for esophageal cancer, including esophageal resections. Please note that this video contains images from a real procedure and may cause discomfort for some viewers.
David Rattner, MD, Co-Chief of the Massachusetts General Hospital Digestive Healthcare Center describes how chronic heartburn can lead to other serious conditions, who is most at risk and how Barrett's esophagus and esophageal cancer can be diagnosed and treated.