Barrett’s esophagus is a condition impacting the esophagus, the tube between the mouth and stomach. 

While it increases the risk of cancer, the overall risk remains low. Regular check-ups and treatment, if necessary, can help reduce the risk.

What is Barrett’s esophagus?

Barrett’s esophagus is a change in the normal lining of the esophagus changes. During an endoscopy, where a doctor uses a small camera to examine your esophagus, the affected lining looks different from normal.

“Normally, the color of the lining of the esophagus is light pinkish, and the Barrett’s esophagus is what we call ‘salmon-colored,’” says gastroenterologist Ishfaq Bhat, MD.

To confirm the diagnosis, doctors take small tissue samples, or biopsies, during the endoscopy. Under a microscope, they look for cells that shouldn’t be in the esophagus.

Cause and symptoms

The main cause of Barrett’s esophagus is long-term acid reflux, also called gastroesophageal reflux disease (GERD). This happens when stomach acid flows back into the esophagus, damaging the lining over time.

“We know that reflux is an important component,” Dr. Bhat says. “However, not everyone with acid reflux gets Barrett’s esophagus.” 

Barrett’s esophagus itself may not cause symptoms. However, most people with Barrett’s have long-term acid reflux, which can cause:

• Heartburn or chest pain.
• Acid or food coming back up into the throat.
• Trouble swallowing.
• Chronic cough or hoarse voice.

Who is at risk for Barrett’s esophagus?

Some things make you more likely to develop Barrett’s esophagus:

• Long-term GERD (more than five years).
• Being male (Barrett’s affects men about three times more than women).
• Age 50 or older.
• Being white.
• Being overweight, especially carrying extra weight around the belly.
• Smoking.
• Family history of Barrett’s esophagus or esophageal cancer.

If you have three or more risk factors, especially with symptoms of acid reflux, talk with your doctor about whether you should be checked for Barrett’s esophagus.

Can Barrett’s esophagus turn into esophageal cancer?

Yes. Barrett’s esophagus can turn into esophageal cancer, which is why it’s important that it is diagnosed, monitored and treated.

The condition exists on a scale:

1. Normal esophagus: Healthy tissue with no changes.
2. Barrett’s esophagus: Changes in the lining but no precancerous cells.
3. Low-grade dysplasia: Early precancerous cell changes.
4. High-grade dysplasia: More advanced precancerous changes.
5. Esophageal cancer.

How is Barrett’s esophagus managed and monitored?

Management usually involves three main strategies:

• Lifestyle changes: Making changes to reduce acid reflux can help protect your esophagus. This means watching what and when you eat, keeping a healthy weight, changing how you sleep and limiting foods that cause reflux.
• Medications: Proton pump inhibitors (PPIs) are medicines that reduce stomach acid. Common examples include omeprazole and pantoprazole. Even if you don’t have reflux symptoms, taking a PPI once daily helps protect your esophagus if you have Barrett’s esophagus.
• Regular surveillance: If you have Barrett’s esophagus without dysplasia, you’ll need a follow-up upper GI endoscopy every three to five years to check for changes. The exact timing depends on factors such as how much of the esophagus is affected, your age and family history.

“With appropriate surveillance, we can likely detect any progressive changes and manage them appropriately,” Dr. Bhat says.

What if dysplasia is found?

If tissue samples show dysplasia (abnormal cell changes), treatment depends on whether it’s low-grade or high-grade:

Low-grade dysplasia

Your doctor may suggest either more frequent check-ups (every six months to one year) or treatment, depending on your age, overall health and the degree of the condition.

High-grade dysplasia

Treatment is strongly recommended to treat the abnormal tissue. This is done through an endoscopy rather than through open surgery.

Treatment involves two steps:

1. Removing visible bumps or irregular areas: These are taken out and looked at under a microscope to rule out cancer.
2. Ablation therapy: The remaining Barrett’s tissue is treated with either heat (radiofrequency ablation) or cold (cryoablation) to get rid of abnormal cells

Treatment may require several sessions about three months apart. During this time, patients take acid-reducing medicine twice daily to help with healing. The goal is to get rid of the dysplasia to prevent cancer.

What should you do if you’re at risk?

If you have long-term acid reflux or several risk factors for Barrett’s esophagus, talk with your primary care doctor or a gastroenterologist about whether screening is right for you.

Pay attention to the warning signs: 

• Trouble swallowing.
• Weight loss you didn’t plan.
• Worsening acid reflux symptoms.
• Vomiting blood or blood in stool.

Reassuring news

“Barrett’s esophagus is not a death sentence,” Dr. Bhat says. “The risk of progression is there, but with appropriate surveillance, we can detect any progressive changes and manage them appropriately.”