What Is Barrett's Esophagus? Symptoms, Causes, and Treatment
Key takeaways:
Barrett’s esophagus occurs when the lower part of the esophagus becomes damaged from long-term exposure to stomach acid traveling up into the esophagus.
Risk factors for Barrett's esophagus include male sex, age over 50, and increased body fat around the abdomen. Other factors are smoking and having gastroesophageal reflux disease (GERD) for more than 5 years.
Barrett's esophagus can increase someone’s risk for developing esophageal cancer. But with proper treatment and monitoring of the condition, the risk of cancer is decreased.
Table of contents
Barrett’s esophagus refers to changes in the esophagus that can lead to esophageal cancer. This condition isn’t common. It affects about 6% of people in the U.S. And it’s much more common in North America than in Europe and Asia.
Barrett's esophagus often doesn’t cause symptoms, and many of those affected don’t know they’re at risk. So knowing about risk factors and screening recommendations is important.
Here, we’ll discuss the symptoms, risk factors, and diagnosis of Barrett’s esophagus, along with treatment and prevention.
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What is Barrett's esophagus?
Barrett's esophagus happens when the cells lining the esophagus are replaced with a different type of cell. These new cells are similar to those found in the intestine. This process can occur when stomach acid travels up from the stomach, damaging the esophageal cells.
Barrett's esophagus is the only known condition that leads to cancer of the esophagus (known as esophageal adenocarcinoma). Up to 12% of people with the condition will develop esophageal cancer. More people are getting Barrett’s esophagus and esophageal cancer in the Western hemisphere. This is likely due to lifestyle risk factors (more on this below).
Barrett’s esophagus symptoms
Barrett's esophagus itself doesn’t cause any symptoms. But it’s linked with gastroesophageal reflux disease (GERD), which may cause symptoms. When GERD symptoms are present, the most common ones include:
A burning sensation in the chest or throat (heartburn)
Sour or acidic taste in the mouth
Chronic or long-standing cough
Nausea
Hoarse voice
Trouble swallowing
But it’s important to keep in mind that not everyone with GERD symptoms will develop Barrett's esophagus. Less than 1 in 100 people with GERD develop Barrett's esophagus.
What’s more, some people with Barrett's esophagus may not experience any GERD symptoms, either. This is especially the case if it only affects a small part of their esophagus. A small number of people with Barrett's esophagus don’t have GERD.
What causes Barrett's esophagus?
Experts aren’t sure exactly what causes Barrett's esophagus. Regularly having gastric acid in your esophagus causes a change in cells. But it’s not clear why some people get Barrett's esophagus and others don’t.
Heartburn can be very uncomfortable. It helps to know what medications and home remedies can help it go away fast.
Heartburn can also be scary, due to chest pain. Additional symptoms with chest pain could point to a heart attack.
Proton pump inhibitors (PPIs) are medications for treating GERD. Side effects are rare, but PPIs should be taken on an empty stomach.
Researchers have identified several risk factors for developing Barrett's esophagus. These things make someone more likely to have it:
Age over 50
White race
Male sex
Increased abdominal fat
Smoking
Chronic GERD symptoms (weekly symptoms for at least 5 years)
A family history of Barrett's esophagus or esophageal cancer
How is Barrett's esophagus diagnosed?
The best way to diagnose Barrett's esophagus is with an upper endoscopy procedure. This procedure involves using a camera to look down into your esophagus. A gastroenterologist is the specialist who usually performs this procedure. They can then take small biopsy samples from the esophagus if it appears abnormal.
These samples are sent to a pathologist, a specialist who looks at the samples under the microscope to make the diagnosis. The cells will have a specific appearance when Barrett's esophagus is present. The pathologist will also look for any sign of dysplasia, or precancerous appearance. Barrett's esophagus may be associated with no dysplasia at all, low-grade dysplasia, or high-grade dysplasia. The degree of dysplasia helps to determine the treatment strategy.
There are other screening options that don’t require endoscopy, but they’re less common. They include various devices that collect cells from the esophagus after being swallowed. These methods don’t require sedation. But these methods are newer, and so they haven’t been studied as much. Your gastroenterologist can help you decide which option is best for you.
Who should get screened for Barrett’s esophagus?
You should get screened for Barrett’s esophagus if you have any three of the risk factors mentioned above — even if you don’t have GERD. That’s because many people diagnosed with Barrett's esophagus and cancer don’t have chronic GERD symptoms.
But, if you’re a man with chronic GERD symptoms and three other risk factors, too, then some expert groups say your need to get screened is even higher.
Understanding your symptoms and risks can be confusing, and that’s OK. If you have any Barrett's esophagus risk factors, consider speaking with a medical professional. They can discuss screening tests with you and help you weigh the risks and benefits.
Barrett’s esophagus treatment
Treatment options for Barrett's esophagus include:
Lifestyle changes
Medications
Regular monitoring
Endoscopic therapies
Depending on the results of your tests, one or more of these treatment approaches may be recommended.
Lifestyle changes
Experts recommend lifestyle changes to reduce the risk factors linked with Barrett's esophagus. These include:
Weight loss
Quitting smoking
Dietary changes
It may help to eat smaller, more frequent meals. This will help avoid filling your stomach and causing acid to come back up into your throat. Another dietary change to try is avoiding certain foods that may trigger GERD. These may include fatty foods, peppermint, or acidic foods like tomatoes. But unless a specific food triggers your symptoms, there’s no need to cut it out from your diet completely.
Medications
Treatment with medications called proton pump inhibitors (PPIs) is recommended for all people with Barrett's esophagus. These medications can help to control GERD by reducing the amount of acid in the stomach and esophagus. This helps to prevent further damage to the esophageal tissue, allowing it to heal.
Monitoring endoscopy
Your healthcare professional will probably recommend a repeat endoscopy to keep an eye on things. How often you’ll need this depends on:
How much of your esophagus is affected by Barrett's esophagus
The degree of dysplasia found on the biopsy
This isn’t a treatment, but we’ve included it here since it’s an important management strategy.
Destroying the abnormal cells
The abnormal esophageal cells can be destroyed during an endoscopy procedure. This is called endoscopic eradication therapy, or EET.
There are a few ways to do this. But the preferred method uses radio waves to damage the abnormal cells. Your healthcare team will recommend an endoscopy schedule after EET to be sure Barrett's esophagus doesn’t come back.
How to prevent Barrett’s esophagus
Some risk factors for Barrett's esophagus aren’t in our control, like:
Genetics
Assigned sex at birth
Age
Race
But there are some risk factors that we have the power to change. Here are a few prevention strategies for Barrett's esophagus:
Maintain a comfortable weight.
Eat smaller, more frequent meals instead of large meals that may cause GERD.
Avoid foods and drinks that can trigger reflux.
If you have GERD, make sure you discuss your symptoms with a healthcare professional. They can help you find management strategies, like lifestyle changes or medication.
Frequently asked questions
Barrett's esophagus isn’t cancer. And so people can live with it for many years. But Barrett's esophagus can progress to esophageal cancer, which is a rare and sometimes aggressive cancer. Finding and treating Barrett's esophagus will help prevent this progression.
Treatment of Barrett's esophagus by removing and destroying abnormal cells can cure it. But recurrence is possible, meaning it can come back. This is more likely with high-grade dysplasia versus low-grade or no dysplasia. That’s why regular monitoring is so important.
The bottom line
Barrett’s esophagus is a condition that likely results from long-term GERD. But you won’t know if you have it unless you have an upper endoscopy for diagnosis.
People with risk factors for Barrett's esophagus should consider talking to their primary care provider to find out if they should consider this procedure for screening. It helps to know if you have Barrett's esophagus so you can get the right treatment for the condition and prevent its possible progression to cancer.
Why trust our experts?
References
American Cancer Society. (2020). What is cancer of the esophagus?
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American Gastroenterological Association. (2024). New guideline: Barrett’s esophagus can precede esophageal cancer, but not all patients need a procedure to remove abnormal cells.
Burke, Z. D., et al. (2012). Barrett's metaplasia as a paradigm for understanding the development of cancer. Current Opinion in Genetics & Development.
Hayeck, T. J., et al. (2011). The prevalence of Barrett’s esophagus in the US: Estimates from a simulation model confirmed by SEER data. Diseases of the Esophagus.
Muthusamy, V. R., et al. (2023). AGA clinical practice update on new technology and innovation for surveillance and screening in Barrett’s esophagus: Expert review. Clinical Gastroenterology and Hepatology.
National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Eating, diet, & nutrition for Barrett's esophagus. National Institutes of Health.
National Institute of Diabetes and Digestive and Kidney Diseases. (2024). Treatment for Barrett's esophagus. National Institutes of Health.
Saha, B., et al. (2024). Prevalence of Barrett’s esophagus and esophageal adenocarcinoma with and without gastroesophageal reflux: A systematic review and meta-analysis. Clinical Gastroenterology and Hepatology.
Sawas, T., et al. (2022). Limitations of heartburn and other societies’ criteria in Barrett’s screening for detecting de novo esophageal adenocarcinoma. Clinical Gastroenterology and Hepatology.
Shaheen, N. J., et al. (2023). Diagnosis and management of Barrett’s esophagus: An updated ACG guideline. The American Journal of Gastroenterology.
Taylor, J. B., et al. (2010). Meta-analyses of the effect of symptoms of gastroesophageal reflux on the risk of Barrett's esophagus. The American Journal of Gastroenterology.
Thrift, A. P. (2021). Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nature Reviews Gastroenterology & Hepatology.
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