Barrett’s Esophagus
Barrett’s esophagus is a condition that can develop in people with long-term gastroesophageal reflux disease (GERD). In this condition, the normal lining of the esophagus changes to resemble the lining of the stomach or intestines, which are better able to tolerate stomach acid. While Barrett’s esophagus slightly increases the risk of developing esophageal cancer, the overall risk is low for most people, although certain factors can increase this risk, as discussed below.
About Barrett’s Esophagus
When acid from the stomach repeatedly flows back into the esophagus, it can damage the normal tissue. Over time, the inner lining may transform into tissue that looks more like the stomach or intestinal lining. During an endoscopy, this change appears as salmon-colored tissue instead of the normal pale lining.
Barrett’s esophagus is considered a premalignant condition, a condition that could possibly turn into cancer in the future, because it can increase the risk of esophageal adenocarcinoma, a type of cancer that forms in the glandular cells of the esophagus. However, most patients with Barrett’s esophagus will never develop cancer.
Symptoms of Barrett’s Esophagus
Barrett’s esophagus itself does not usually cause symptoms. Instead, most patients experience symptoms of chronic gastroesophageal reflux disease (GERD).
Symptoms may include:
- Frequent heartburn
- Regurgitation of food or stomach acid
- Chest pain or discomfort
- Difficulty swallowing (dysphagia)
Risk Factors for Barrett’s Esophagus
Barrett’s esophagus is more likely to develop in people with a history of long-term acid reflux or previous damage to the esophagus from reflux.
Risk factors may include:
- GERD
- Being male
- Being over age 50
- White ethnicity
- Obesity, especially carrying excess weight in the abdomen
- Smoking
Diagnosing Barrett’s Esophagus
Because Barrett’s esophagus often does not cause symptoms on its own, it is usually detected during an endoscopy, a procedure where a thin, flexible tube with a camera is used to look inside your esophagus, stomach, and upper intestine. Your doctor may recommend a screening endoscopy if you have a history of long-term GERD.
At UT Medicine, we use several advanced techniques to improve detection and understand each patient’s level of risk, including:
- Forceps biopsies: Small tissue samples taken during endoscopy
- Optical endomicroscopy: A tool that provides real-time, microscope-level views of the esophageal lining
- Specialized brush biopsies (WATS3D): Collects wider and deeper samples for more accurate results
- TissueCypher: Specialized genetic testing of biopsies samples to predict the likelihood of developing esophageal cancer
These technologies can increase detection rates 2–4 times higher than standard biopsies alone.
Treating Barrett’s Esophagus
Treatment depends on whether abnormal changes in the cells (dysplasia) are present:
- Without dysplasia: Regular monitoring with endoscopy every 3–5 years. Acid control with medication or, in some cases, anti-reflux surgery may be recommended.
- With dysplasia: Treatment may involve radiofrequency ablation (RFA), a minimally invasive procedure that uses heat to remove abnormal cells and reduce the risk of cancer.
