From the Guidelines
Barrett's esophagus is a condition where the normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine due to chronic acid reflux, carrying an increased risk of esophageal cancer, with an annual risk of approximately 0.5% 1. This condition typically arises from gastroesophageal reflux disease (GERD), where stomach acid damages the lower esophagus, prompting the body to alter the esophagus lining cells, which can eventually develop into esophageal cancer over time. Some key points to consider about Barrett's esophagus include:
- The disease is strongly associated with chronic reflux, as noted in a study published in JAMA 1
- Symptoms often mirror those of GERD, including heartburn, regurgitation, chest pain, and difficulty swallowing, although some individuals may not exhibit any symptoms
- Treatment primarily involves managing acid reflux through medications, lifestyle adjustments, and regular endoscopy monitoring to detect precancerous changes
- If high-grade dysplasia is present, the cancer risk exceeds 25%, and endoscopic modalities may be employed to remove abnormal tissue before it progresses to cancer, as pharmacologic therapies have been largely unsuccessful in reducing cancer risk 1.
From the Research
What is Barrett's Esophagus
- Barrett's esophagus is a condition where the normal lining of the esophagus is replaced with abnormal cells, known as columnar metaplasia 2
- This condition affects approximately 5% of people in the US and 1% worldwide 2
- It is often associated with gastroesophageal reflux disease (GERD) and can increase the risk of developing esophageal adenocarcinoma 2, 3
Causes and Risk Factors
- The main risk factor for Barrett's esophagus is GERD, which causes stomach acid to flow back into the esophagus 3
- Other risk factors include older age, male sex, and smoking 2
- Approximately 3% to 5% of patients with Barrett's esophagus will develop esophageal adenocarcinoma in their lifetime 2
Symptoms and Diagnosis
- Barrett's esophagus often has no symptoms, but it can be diagnosed with an upper endoscopy and biopsy 2, 4
- The Prague classification and Seattle protocol are used to describe and diagnose Barrett's esophagus 4
Treatment and Management
- Treatment for Barrett's esophagus typically involves acid-suppressive medications, such as proton pump inhibitors (PPIs), to reduce symptoms of GERD 2, 5
- Surveillance endoscopy is recommended every 3 to 5 years to monitor for progression to esophageal adenocarcinoma 2
- Endoscopic therapy, such as radiofrequency ablation, can be used to treat dysplasia or early cancer in patients with Barrett's esophagus 4