Barrett's Esophagus

Digestive Diseases

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Symptoms of Barrett's Esophagus
Risk Factors for Barrett's Esophagus
Diagnosis and Surveillance of Barrett's Esophagus
Treatment for Barrett's Esophagus
Research for Barrett's Esophagus
Contact Information

Barrett's esophagus is a precancerous condition of the esophagus. It develops when cells in the esophagus become damaged by chronic gastroesophageal reflux disease (GERD). The abnormal cells, chronically exposed to stomach acid, and bile, lose their normal character and take on characteristics of cells that normally line the intestine. This process is called intestinal metaplasia. Barrett's esophagus is a risk factor for esophageal adenocarcinoma.

Symptoms of Barrett's Esophagus

Barrett's esophagus causes no symptoms but is preceded by gastrointestinal reflux disease, or GERD, which is characterized by chronic heartburn caused by reflux of the stomach's contents into the esophagus.

Risk Factors for Barrett's Esophagus

The primary risk factor for developing Barrett's esophagus is GERD. While individuals who do not have chronic heartburn or GERD may develop Barrett's esophagus, those who do have GERD are 30-50% more likely to be diagnosed with this condition. Other risk factors include being older, and being a white male.

Diagnosis and Surveillance of Barrett's Esophagus

Our physicians offer a number of promising techniques for the diagnosis and surveillance of Barrett's esophagus. Initially, our gastrointestinal experts will perform an upper gastrointestinal (GI) endoscopy. In this procedure, a physician will insert a thin, flexible tube into the esophagus via the mouth or nose. Using the endoscope, which is equipped with a light and miniscule camera, the physician will examine the esophagus, and if the tissue appears suspicious, will take a biopsy via the endoscope. Our pathologists will examine the tissue to determine the exact diagnosis. Patients can return to normal activities the same day following an endoscopic biopsy.

Physicians may also use a technique known as narrow band imaging. During a gastrointestinal (GI) endoscopy, a high-resolution video endoscope which houses electronic magnification and emits a blue light, is used to produce very detailed images of the esophagus.

For patients who are unable to tolerate an upper endoscopy, we may use a non-invasive method, capsule endoscopy (camera pill). The camera pill resembles a pill. When swallowed, it takes photos as it travels through the esophagus and these photos are transmitted via a radio frequency to a recording device worn around the patient's waist. The pill is later excreted.

Treatment for Barrett's Esophagus

We specialize in minimally invasive treatments for Barrett's esophagus. Patients who develop mucosal carcinoma or local lesions of high-grade dysplasia (abnormal cells) can benefit from endoscopic mucosal resection (EMR). Using an endoscope, physicians can treat abnormal areas by injecting solution under the lining of the Barrett's area and applying suction to remove the abnormal tissue. While this procedure cannot always remove all of the Barrett's lining, it can be used to remove a small cancer or a localized area of high-grade dysplasia.

If EMR is used to treat an early-stage cancer, our specialists will perform an endoscopic ultrasound beforehand to make sure that the cancer involves only the very top layer of cells and is, therefore, an intramucosal cancer – one located on the top mucous layer of esophageal cells. EMR can provide a definitive proof of the tumor's depth. Healing usually takes about 4-8 weeks; risks of this procedure include bleeding.

Research for Barrett's Esophagus

We are currently exploring several new techniques to minimize the effects of Barrett's esophagus: chemoprevention, radiofrequency ablation, and cryoablation.

For chemoprevention, our physicians are conducting clinical trials sponsored by the National Cancer Institute using an extract of green tea, called Polyphenon E, to determine if it can prevent further damage from Barrett's esophagus. This natural extract has demonstrated notable activity against the development of esophageal cancer in a number of laboratory models of the disease.

We are also testing radiofrequency ablation as a technique to remove larger areas of abnormal Barrett's lining. Radiofrequency ablation employs radio waves to heat and kill abnormal tissue while patients are deeply sedated.

Lastly, our physicians are exploring using cryoablation where low-pressure liquid nitrogen spray is delivered via an endoscope to freeze and destroy abnormal tissue.