Barrett's Esophagus Fact Book
Barrett's esophagus is a condition in which the esophagus, the muscular
tube that carries food and saliva from the mouth to the stomach, changes
so that some of its lining is replaced by a type of tissue similar to that
normally found in the intestine. This process is called intestinal
While Barrett's esophagus may cause no symptoms itself, a small number
of people with this condition develop a relatively rare but often deadly
type of cancer of the esophagus called esophageal adenocarcinoma.
Barrett's esophagus is estimated to affect about 700,000 adults in the
United States. It is associated with the very common condition
gastroesophageal reflux disease or GERD.
Normal Function of the Esophagus
The esophagus seems to have only one important function in the body--to
carry food, liquids, and saliva from the mouth to the stomach. The stomach
then acts as a container to start digestion and pump food and liquids into
the intestines in a controlled process. Food can then be properly digested
over time, and nutrients can be absorbed by the intestines.
The esophagus transports food to the stomach by coordinated
contractions of its muscular lining. This process is automatic and people
are usually not aware of it. Many people have felt their esophagus when
they swallow something too large, try to eat too quickly, or drink very
hot or very cold liquids. They then feel the movement of the food or drink
down the esophagus into the stomach, which may be an uncomfortable
The muscular layers of the esophagus are normally pinched together at
both the upper and lower ends by muscles called sphincters. When a person
swallows, the sphincters relax automatically to allow food or drink to
pass from the mouth and into the stomach. The muscles then close rapidly
to prevent the swallowed food or drink from leaking out of the stomach
back into the esophagus or into the mouth. These muscles make it possible
to swallow while lying down or even upside-down. When people belch to
release swallowed air or gas from carbonated beverages, the sphincters
relax and small amounts of food or drink may come back up briefly; this
condition is called reflux. The esophagus quickly squeezes the material
back into the stomach, and this is considered normal.
While these functions of the esophagus are obviously an important part
of everyday life, people who must have their esophagus removed, for
example because of cancer, can live a relatively healthy life without
Having liquids or gas occasionally reflux is considered normal. When it
happens frequently, particularly when not trying to belch, and causes
other symptoms, then it is considered a medical problem or disease.
However, it is not necessarily a serious one or one that requires seeing a
The stomach produces acid and enzymes to digest food, and when this
mixture refluxes into the esophagus more frequently than normal or for a
longer period of time than normal, it may produce symptoms. These
symptoms, often called acid reflux, are usually described by people as
heartburn, indigestion, or "gas." The symptoms typically consist of a
burning sensation below and behind the lower part of the breastbone or
Almost everyone has experienced these symptoms at least once, typically
as a result of overeating. Other things that provoke GERD symptoms include
being overweight, eating certain types of foods, or being pregnant. In
most people, GERD symptoms may last only a short time and require no
treatment at all. More persistent symptoms are often quickly relieved by
over-the-counter acid-reducing agents such as antacids. Common antacids
Other drugs used to relieve GERD symptoms are antisecretory drugs such
as histamine2 (H2) blockers or proton pump inhibitors. Common
H2 blockers are
- cimetidine (Tagamet HB)
- famotidine (Pepcid AC)
- nizatidine (Axid AR)
- ranitidine (Zantac 75)
Common proton pump inhibitors are
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- pantoprazole (Protonix)
- rabeprazole (Aciphex)
People who have symptoms frequently should consult a physician. Other
diseases can have similar symptoms, and prescription medications in
combination with other measures might be needed to reduce reflux. GERD
that is untreated over a long period can lead to complications, such as an
ulcer in the esophagus that could cause bleeding. Another common
complication is scar tissue that blocks the movement of swallowed food and
drink through the esophagus; this condition is called stricture.
Esophageal reflux may also cause certain less common symptoms, such as
hoarseness or chronic cough, and sometimes provokes conditions such as
asthma. While most patients find that lifestyle modifications and
acid-blocking drugs relieve their symptoms, doctors occasionally recommend
surgery. Overall, GERD is one of the most common medical conditions. Some
20 percent of the population can be affected over a lifetime.
GERD and Barrett's Esophagus
The exact causes of Barrett's esophagus are not known, but it is
thought to be caused in part by the same factors that cause GERD. Although
people who do not have heartburn can have Barrett's esophagus, it is found
about three to five times more often in people with this condition.
Barrett's esophagus is uncommon in children. The average age at
diagnosis is 60, but it is usually difficult to determine when the problem
started. It is about twice as common in men as in women and much more
common in white men than in men of other races.
Barrett's Esophagus and Cancer of the Esophagus
Barrett's esophagus does not cause symptoms itself and is important
only because it seems to precede the development of a particular kind of
cancer--esophageal adenocarcinoma. The risk of developing adenocarcinoma
is 30 to 125 times higher in people who have Barrett's esophagus than in
people who do not. This type of cancer is increasing rapidly in white men.
The increase is possibly related to the rise in obesity and GERD.
For people who have Barrett's esophagus, the risk of getting cancer of
the esophagus is small: less than 1 percent (0.4 percent to 0.5 percent)
per year. Esophageal adenocarcinoma is often not curable, partly because
the disease is frequently discovered at a late stage and because
treatments are not effective.
Diagnosis and Screening
Diagnosing Barrett's esophagus is not easy. At the present time, it
cannot be diagnosed on the basis of symptoms, physical exam, or blood
tests. The only useful test is upper gastrointestinal endoscopy and
biopsy. In this procedure, a flexible tube called an endoscope, which has
a light and miniature camera, is passed into the esophagus. If the tissue
appears suspicious, then biopsies must be done. A biopsy is the removal of
a small piece of tissue using a pincher-like device passed through the
endoscope. A pathologist examines the tissue under a microscope to confirm
Looking for a medical problem in people who do not know whether they
have one is called screening. Currently, there are no commonly accepted
guidelines on who should have endoscopy to check for Barrett's esophagus.
Among the many reasons for the lack of firm recommendations about
screening are the great expense and occasional risk of side effects of the
test. Also, the rate of finding Barrett's esophagus is low, and finding
the problem early has not been proven to prevent deaths from cancer.
Many physicians recommend that adult patients who are over the age of
40 and have had GERD symptoms for a number of years have endoscopy to see
whether they have Barrett's esophagus. Screening for this condition in
people who have no symptoms is not recommended.
Barrett's esophagus has no cure, short of surgical removal of the
esophagus, which is a serious operation. Surgery is recommended only for
people who have a high risk of developing cancer or who already have it.
Most physicians recommend treating GERD with acid-blocking drugs, since
this is sometimes associated with improvement in the extent of the
Barrett's tissue. However, this approach has not been proven to reduce the
risk of cancer. Treating reflux with a surgical procedure for GERD also
does not seem to cure Barrett's esophagus.
Several different experimental approaches are under study. One attempts
to see whether destroying the Barrett's tissue by heat or other means
through an endoscope can eliminate the condition. This approach, however,
has potential risks and unknown effectiveness.
Surveillance for dysplasia and cancer
Periodic endoscopic examinations to look for early warning signs of
cancer are generally recommended for people who have Barrett's esophagus.
This approach is called surveillance. When people who have Barrett's
esophagus develop cancer, the process seems to go through an intermediate
stage in which cancer cells appear in the Barrett's tissue. This condition
is called dysplasia and can be seen only in biopsies with a microscope.
The process is patchy and cannot be seen directly through the endoscope,
so multiple biopsies must be taken. Even then, it can be missed.
The process of change from Barrett's to cancer seems to happen only in
a few patients, less than 1 percent per year, and over a relatively long
period of time. Most physicians recommend that patients with Barrett's
esophagus undergo periodic surveillance endoscopy to have biopsies. The
recommended interval between endoscopies varies depending on specific
circumstances, and the ideal interval has not been determined.
Treatment for dysplasia or esophageal adenocarcinoma
If a person with Barrett's esophagus is found to have dysplasia or
cancer, the doctor will usually recommend surgery if the person is strong
enough and has a good chance of being cured. The type of surgery may vary,
but it usually involves removing most of the esophagus and pulling the
stomach up into the chest to attach it to what remains of the esophagus.
Many patients with Barrett's esophagus are elderly and have many other
medical problems that make surgery unwise; in these patients, other
approaches to treating dysplasia are being investigated.
Hope Through Research
Many important questions about Barrett's esophagus need further
- find better ways to identify people who have the problem
- find out what causes it
- test treatments that may prevent or eliminate it
- find better treatments for people who have Barrett's esophagus with
The National Institute of Diabetes and Digestive and Kidney Diseases
and the National Cancer Institute sponsor re-search programs to
investigate Barrett's esophagus.
Points to Remember
- In Barrett's esophagus, the cells lining the esophagus change and
become similar to the cells lining the intestine.
- Barrett's esophagus is associated with gastroesophageal reflux
disease or GERD.
- A small number of people with Barrett's esophagus may develop
- Barrett's esophagus is diagnosed by upper gastrointestinal endoscopy
- People who have Barrett's esophagus should have periodic esophageal
- Taking acid-blocking drugs for GERD may result in improvements in
- Removal of the esophagus is recommended only for people who have a
high risk of developing cancer or who already have it.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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