Barrett's esophagus is a precancerous condition in which the cells that line the lower part of the esophagus are changed or replaced with abnormal cells.

Patients with Barrett's esophagus face an increased risk of developing esophageal cancer, although only an estimated 1 in 200 patients with Barrett's esophagus develops cancer, according to the American Academy of Family Physicians.

The exact cause of Barrett's esophagus is unknown, but it is sometimes associated with gastroesophageal reflux disease (GERD). GERD is a disorder in which stomach contents flow back (reflux) into the esophagus and damage its lining. Although GERD is common, the number of patients who develop Barrett's esophagus due to GERD is small.

Caucasians, Hispanics, men, people over age 50, smokers and obese individuals also have an increased risk of developing Barrett’s esophagus.

Barrett's espophagus does not produce any symptoms. However, patients may experience heartburn, difficulty swallowing, bleeding, unexplained weight loss and loss of appetite as a result of GERD, which is sometimes associated with Barrett's esophagus.

Barrett's esophagus may be diagnosed by a physician during a physical examination with a medical history and list of medications. The condition is usually diagnosed during an endoscopy that includes a biopsy. Patients with a higher risk of developing Barrett's esophagus may receive regular endoscopies to screen for the condition or monitor its progression.

Early detection and treatment of GERD may help prevent the onset of Barrett’s esophagus in some cases.

There is no cure for Barrett's esophagus, but treatment is similar to that for GERD. This may include lifestyle changes such as avoiding alcohol and foods that cause reflux. Treatment may also include taking acid-reducing medications such as proton pump inhibitors. In severe cases, patients may undergo a surgical procedure such as esophagectomy to remove the esophagus.

Barrett’s esophagus is a precancerous condition in which the normal cells that line the lower esophagus are replaced with abnormal cells that resemble those found in the stomach and intestines. Once these changes have occurred, the condition is irreversible.

The esophagus is a muscular tube that transports food from the mouth into the stomach by involuntary contractions of its muscular lining. The muscular layers of the esophagus are pinched together at both ends by muscles called sphincters. After swallowing, the sphincters relax to allow food to pass from the mouth to the stomach. After food reaches the stomach, the lower esophageal sphincter (LES) muscles close to prevent stomach contents from flowing back into the esophagus or mouth (refluxing).

When the LES is weakened or remains relaxed for too long, stomach contents can reflux into the esophagus. The tissue lining the esophagus differs from the stomach lining and is more susceptible to acid. This causes a burning sensation in the chest or throat called heartburn.

When the lining of the esophagus is exposed to stomach acid over a prolonged period of time, it can result in cell changes. When normal cells are replaced with abnormal cells in the esophagus, it is called specialized intestinal metaplasia. It is believed that specialized intestinal metaplasia occurs because the new cells are more resistant to stomach acid than the normal cells in the esophagus. However, the new cells face a small risk of becoming cancerous.

Barrett’s esophagus is sometimes referred to as short- or long-segment Barrett’s esophagus based on the length of the affected portion of the esophagus. Medical management of both types is the same. Short-segment occurs when less than 3 centimeters (1.18 inches) of the esophagus is impacted and long-segment occurs when 4 centimeters (1.57 inches) or more is impacted.

Barrett’s esophagus is a potential complication of a common condition called gastroesophageal reflux disease (GERD). GERD is a disorder in which stomach contents flow back (reflux) into the esophagus and damage its lining. Although GERD is common, the number of people who develop Barrett’s esophagus due to GERD is small. It is not completely understood why only a small number of people with GERD ever develop Barrett’s esophagus.

It is estimated that about 700,000 adults in the United States are affected by Barrett’s esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Approximately 20 percent of people in the United States have GERD symptoms once a week, according to the International Foundation for Functional Gastrointestinal Disorders (IFFGD). Although Barrett’s esophagus often does not produce symptoms, it is important to recognize the condition because patients face a higher risk for developing cancer of the esophagus (esophageal adenocarcinoma), which can be fatal. Esophageal cancer can also spread to nearby lymph nodes and other parts of the body, and is considered one of the deadliest forms of cancer.

However, the number of patients with Barrett’s esophagus who develop cancer is small. It is estimated that approximately 1 in 200 patients with Barrett’s esophagus develops esophageal cancer, according to the American Academy of Family Physicians.

The exact cause of Barrett’s esophagus is not known, but it is sometimes associated with a common condition called gastroesophageal reflux disease (GERD).

GERD is a disorder in which stomach contents flow back (reflux) into the esophagus and damage its lining. GERD occurs when the lower esophageal sphincter (LES), which separates the esophagus and stomach, does not close properly. The most common symptom of GERD is heartburn, a burning sensation in the upper abdominal or chest area.

It is normal to experience a small amount of reflux after a meal. It is also normal to experience an occasional episode of heartburn. Patients with GERD experience heartburn and other symptoms more frequently than other people, and may have damage to the esophagus.

It is estimated that approximately 20 percent of adults in the United States experience symptoms of GERD at least once a week, according to the American Academy of Family Physicians. When chronic GERD is not treated properly, it may cause potential complications, such as Barrett’s esophagus.

In addition, research has found that individuals with Barrett’s esophagus and esophageal cancer often have increased levels of reactive oxygen (e.g., hydrogen peroxide) and an enzyme called NOX5 in their cells. When NOX5 is exposed to acid, the composition of the cells appears to change significantly, producing the excess hydrogen peroxide and creating optimal conditions for cancer cells to flourish.

Other risk factors for Barrett’s esophagus include:

• Being Caucasian or Hispanic. Caucasians and Hispanics develop Barrett's esophagus more frequently than people who are black or Asian.
  
  
• Gender. Men have a greater risk of developing the condition than women.
  
  
• Advanced age. The condition is more common in people over age 50. Most people diagnosed with Barrett's esophagus are over age 60.
  
  
• Smoking. Cigarette smoking increases the risk of developing the condition.
  
  
• Obesity. People who are obese have a greater risk of developing Barrett’s esophagus.

Barrett's esophagus produces no symptoms. However, patients with the condition may experience symptoms of gastroesophageal reflux disease (GERD), wich is sometimes associated with Barrett's esophagus.

Patients should contact their physician if they experience any of the following signs and symptoms, which may indicate GERD or potential complications such as Barrett’s esophagus. They include:

• Heartburn. This includes patients with heartburn that occurs frequently (more than three times a week) and those who experienced heartburn over many years.
  
  
• Difficulty swallowing (dysphagia). An esophageal stricture (narrowing of the esophagus) may lead to swallowing problems.
  
  
• Bleeding. Patients may vomit red blood or blood that resembles coffee grounds. They may also experience stools that are black, tarry or bloody.
  
  
• Unexplained weight loss or loss of appetite. Patients may experience weight loss or loss of appetite that cannot be explained.

Patients who suspect that they may have Barrett's esophagus should consult a physician. A physical examination that includes a medical history and list of medications may be performed. Patients may be referred to a gastroenterologist, which is a physician that specializes in the function and disorders of the gastrointestinal tract.

Though Barrett's esophagus produces no symptoms, patients may experience signs and symptoms of gastroesophageal reflux disease (GERD), a condition sometimes associated with Barrett's esophagus. A physician will determine if a patient has Barrett's espohagus by performing an upper endoscopy. This procedure involves inserting an endoscope (lighted tube with a tiny camera) into the mouth and through the esophagus into the stomach. Patients may receive an anesthetic or be sedated during the procedure.

Endoscopy allows physicians to look for abnormal cell changes (dysplasia). Dysplasia can be detected when the color of the tissue lining in the esophagus changes from pink to salmon. During endoscopy, a physician can also detect abnormalities in the junction between the stomach and the esophagus (gastroesophageal junction). In a healthy patient, the junction is located at the lower end of the esophagus. In patients with Barrett's esophagus, the junction is located higher up the esophagus.

A biopsy is conducted during endoscopy to diagnose Barrett's esophagus. This involves removing a small sample of tissue, which is sent to a laboratory where it is studied under a microscope for the presence of abnormal cells.

Patients with significant risk factors for the condition may be screened for its presence with an endoscopy. Currently there are no medical guidelines to identify patients who should be screened for Barrett’s esophagus because the condition is rare and diagnostic tests may be expensive and cause side effects.

However, some physicians recommend that patients over age 40 who have experienced symptoms of gastroesophageal reflux disease (GERD) for many years be screened for Barrett's esophagus. GERD is a disorder in which stomach contents flow back (reflux) into the esophagus and damage the lining. Barrett’s esophagus is a potential complication of GERD.

Patients that undergo an endoscopy and biopsy that reveal no abnormal cells may receive screening endoscopies every three to five years.

Gastroesophageal reflux disease (GERD) is a condition sometimes associated with Barrett’s esophagus in which stomach contents flow back (reflux) into the esophagus and damage its lining. Early detection and treatment of GERD may help prevent the onset of Barrett’s esophagus in some cases.

Treatment for Barrett's esophagus involves three components. They include prompt treatment of gastroesophageal reflux, adequate endoscopic surveillance to detect dysplasia (abnormal cell changes that may indicate early cancer) and treatment of dysplasia (if applicable). Treating GERD may also help prevent patients with Barrett's esophagus from developing esophageal cancer.

Historically, GERD has been treated (or prevented) by making lifestyle changes to reduce reflux. Such changes include:

• Avoiding foods that cause reflux, such as chocolate, coffee, spicy foods and fatty foods.
  
  
• Avoiding eating meals too close to bedtime.
  
  
• Avoid lying down too soon after eating.
   
• Raising the head of the bed 6 to 8 inches (15.2 to 20.3 centimeters).
  
  
• Quitting smoking.
  
  
• Avoiding alcohol.
  
  
• Avoiding medications that may contribute to reflux (e.g., sedatives, tranquilizers, certain sleeping pills). Patients may speak with their physician regarding alternative medications.
   
• Losing weight.
  

However, it is important to note that recent research questions the effectiveness of dietary changes in treating or preventing GERD, and there is little evidence to support that reclining after meals can prevent or reduce heartburn associated with the condition.

Treatment may also include medications, such as:

• Proton pump inhibitors. Medications that reduce the amount of stomach acid by inhibiting its production by certain cells. They are available over-the-counter and by prescription.
  
  
• H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over-the-counter and by prescription.

Patients that receive medications may experience symptom improvement. However, they still have a risk of developing cancer.

Patients with more advanced cases of GERD or Barrett's esophagus may require surgery. Surgery is usually performed only on patients with a high risk of developing cancer. Types of surgery patients may receive include:

• Fundoplication. This involves wrapping the upper part of the stomach around the lower esophageal sphincter (LES) to strengthen it and prevent acid reflux. The procedure can be performed laparoscopically. A few tiny incisions are made in the abdomen and a laparoscope is inserted. A laparoscope is a thin tube with a video camera and it can be fitted with surgical instruments. Though this is an effective method for controlling symptoms of GERD, it will not reverse Barrett's esophagus and patients still face a risk of developing cancer.
  
  
• Esophagectomy. Patients who have a high level of cell changes due to Barrett's esophagus or who have developed cancer may undergo an esophagectomy. This involves completely removing the esophagus and pulling the stomach into the chest. Although it is an effective treatment, its use is controversial because it can result in serious complications such as pneumonia, heart attack, infection and death. Some physicians recommend the procedure only in patients who have already developed esophageal cancer.
  

It is important to note, however, that research indicates that patients who undergo surgery for esophageal cancer have a much higher 5-year-survival rate than in previous years.

There is considerable research being conducted on Barrett's esophagus. Some of the research is aimed at finding improved methods for detecting Barrett's esophagus and the cell changes that occur with it (dysplasia). Other research involves developing treatments to reverse Barrett’s esophagus after it has developed.

Most of the research regarding the diagnosis of Barrett's esophagus involves modifications to endoscopy, including:

• Chromoendoscopy. Uses special dyes to highlight abnormal cells.
  
  
• Magnification endoscopy. Uses high magnification to detect abnormalities.
  
  
• Endoscopic ultrasound. A procedure in which a probe that emits sound waves is inserted through the mouth into the body to produce images of body tissues.
  
  
• Optical coherence tomography. Uses special optical equipment to detect abnormalities.
  
  
• Flourescence detection techniques. Use flourescent dyes to highlight abnormal cells.

There are several alternative treatments for Barrett's esophagus being studied that involve removal (ablation) of tissue impacted by cell change. It is not clear how effective these treatments are and which patients may benefit most from them. They include:

• Photodynamic therapy (PDT). Patients receive injections of chemical agents (photo sensitizers) that make abnormal cells more sensitive to light. A special light source is injected into the esophagus, which causes a reaction that destroys abnormal cells. This procedure, however, is expensive and is not widely available.
  
  
• Electrocautery. An electric wire is inserted into the esophagus and abnormal cells are burned away.
  
  
• Laser therapy. A laser (light beam) is inserted into the esophagus and abnormal cells are burned away.
  
  
• Argon plasma coagulation. A jet of argon gas along with an electric current is released into the esophagus and abnormal cells are burned away.
  
  
• Endoscopic mucosal resection. Saline solution is injected with an endoscope (lighted tube with a tiny camera) in the area of the esophagus that has abnormal cells. A blister forms under the abnormal cells, which allows a physician to remove them without damaging the esophagus. This procedure may be performed with photodynamic therapy.
  

In addition, researchers are currently studying the effectiveness of “triple therapy” in reversing Barrett’s esophagus and eliminating cancer risk in patients with the condition. This approach combines one medication (proton pump inhibitor) to treat acid reflux, one medication to treat reflux of bile and pepsin, and folic acid to prevent abnormal cell changes, or dysplasia.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about Barrett's esophagus:

1. I have gastroesophageal reflux disease (GERD). How likely is it that I will develop Barrett's esophagus?
   
   
2. How likely is it that I will develop cancer due to Barrett's esophagus?
   
   
3. What caused my case of Barrett's esophagus?
   
   
4. Should I be treated by a gastroenterologist?
   
   
5. If I am not experiencing any symptoms, should I receive an endoscopy?
   
   
6. If the results of my endoscopy are normal, should I receive future endoscopies?
   
   
7. How often should I receive an endoscopy?
   
   
8. What lifestyle changes should I make to treat my case of Barrett's esophagus?
   
   
9. What type of medication should I take to treat my case of Barrett's esophagus? For how long will I need to take it?
   
   
10. Should I consider having surgery to treat my case of Barrett's esophagus?