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What is Barrett's Esophagus?

The esophagus is lined with a special type of cell (squamous). This type of cell has very poor protection against acid. In gastroesophageal reflux disease (GERD), stomach acid freely

refluxes or backs up into the esophagus. This can cause heartburn. The lower esophageal cells can change into different cells that provide better protection against the acid. This change is called metaplasia.

While this is a normal protective mechanism, the metaplasia increases the risk of dysplasia (abnormal-looking cells), a condition that could progress to cancer. The metaplasia in the lower esophagus is called Barrett’s Esophagus.

Barrett’s Esophagus occurs when there is significant acid reflux (GERD). This is usually symptomatic and causes heartburn. People with longstanding severe heartburn are at increased risk of Barrett’s Esophagus but it may occur even in an asymptomatic person.

Barrett’s Esophagus is best diagnosed by endoscopy. The endoscopist can identify the abnormal tissue in the lower esophagus and biopsy the area, taking multiple tissue samples.

While the area may look like Barrett’s, only through the microscopic viewing of the biopsies can Barrett’s be diagnosed. Equally important, the microscopic viewing can examine for the presence of dysplasia and its severity.

The risk of developing cancer from Barrett’s is relatively low. However, it is still much greater than a patient without Barrett’s. Some physicians estimate that every year, the risk of developing cancer is 1 in 1,000.

Cancer does not develop without dysplasia occurring first. Therefore, it is very important to screen regularly for the presence of dysplasia and its severity.

Treatment of GERD is the best method of preventing Barrett’s Esophagus from getting worse. About 25% of patients with Barrett’s will have it disappear with vigorous treatment. Surgery will give the same results. Therefore, vigorously treating GERD will give you the best results.

Regular endoscopies will allow your doctor to monitor dysplasia and its response to treatment. In the event of severe dysplasia, non-surgical treatment is now available.

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