Barrett’s Treatment

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NYU Langone Hospital – Long Island

Mount Sinai Hospital, New York

Mount Sinai South Nassau

Mercy Medical Center

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What Is the Treatment for Barrett’s Esophagus?

Barrett’s esophagus is a condition brought on by years of severe acid reflux or gastroesophageal reflux disease (GERD). Patients with this condition have damage to the swallowing tube that connects the throat and stomach together. Barrett’s esophagus manifests when the lining of the tube changes from one cell type to another, which puts a patient at a higher risk of contracting esophageal cancer. The best way to prevent or limit Barrett’s esophagus is to arrest the symptoms of acid reflux early on. There are treatments for Barrett’s, but they depend on the severity of the damage and how much abnormal cell growth there is. 

What Are the Symptoms of Barrett’s Esophagus?

A patient with Barrett’s esophagus will likely have had acid reflux for years. The more severe form of acid reflux, or heartburn, is GERD. Right between the esophagus and the lining of the stomach is an important valve, known as the lower esophageal sphincter (LES). This usualy stays closed to prevent stomach acid and other caustic contents from regurgitating into the esophagus. When you eat food or drink a beverage, the LES opens. In patients who have GERD, the LES does not function properly and does not stay closed, leaving stomach acid to find its way into the esophagus. If not treated, over time, the stomach acid damages the lining of the esophagus, and you may experience more severe symptoms. Symptoms of Barrett’s esophagus include:

  • Chronic, frequent, and painful heartburn 
  • Regurgitation of stomach contents into the throat 
  • Difficulty swallowing
  • Chest pain

Chest pain is the least common symptom of Barrett’s esophagus; however, if you experience chest pain, please seek urgent care or see your doctor immediately. 

Am I At Risk for Barrett’s Esophagus?

The most prominent risk factor for Barrett’s esophagus is long-standing GERD or acid reflux. However, there are other factors (typically in combination with GERD) that increase your chances of developing Barrett’s. These include:

  • Current or former smoker
  • Being overweight 
  • Being Caucasian
  • Being male
  • More common in age 50 and above
  • Family history of GERD or Barrett’s esophagus 

If you’re experiencing severe GERD symptoms, especially if acid reflux is constant, you should contact your gastroenterologist so they can offer you diagnosis and treatment. 

How Is Barrett’s Esophagus Diagnosed?

The most common way to test for Barrett’s esophagus is upper endoscopy. While under anesthesia, your gastroenterologist will insert a long, thin tube with a small camera, called an endoscope. The scope can see the first part of the digestive tract, from the mouth to the duodenum (beginning of the small intestine). Your doctor can take a tissue sample of your esophagus with the endoscope and have it tested for Barrett’s esophagus. If Barrett’s esophagus is detected, the results will indicate either no dysplasia, low-grade dysplasia (some precancerous cells), or high-grade dysplasia (stage right before the development of esophageal cancer). The treatment for Barrett’s esophagus depends on the degree of dysplasia. 

What Are the Different Treatments for Barrett’s Esophagus?

The treatment your doctor recommends depends entirely on the degree of dysplasia present in your esophagus. The most common treatments by stage for Barrett’s include:

  • No dysplasia. This means Barrett’s is present, but there are no precancerous cells. For this stage of the disease, your physician will likely have you screened more often via endoscopy to ensure there are no changes in your cells. Your healthcare provider will also want to treat the source of the problem, which is GERD. Making lifestyle changes, such as quitting smoking, medications such as proton pump inhibitors, or surgery to ease a hiatal hernia can help prevent further damage..
  • Low-grade dysplasia. This is the stage where precancerous cells appear, which puts you at high risk for developing esophageal cancer. Your physician will likely call in a pathologist to further examine your biopsy results. Based on their advice, your gastroenterologist may recommend:
    • Cryotherapy. This form of treatment uses an endoscope to apply a cold gas or liquid to the precancerous cells. The cells are allowed to thaw after freezing and are frozen again. Repeating this freeze and thaw cycle kills the abnormal cells. 
    • Endoscopic resection. During this procedure, your doctor will use an endoscope to remove the abnormal cells from your digestive tract.
    • Radiofrequency ablation. This treatment uses a form of thermal energy to burn and removes the Barrett’s tissue. This is the most common form of eradicating Barrett’s tissue with dysplasia.
  • High-grade dysplasia. High-grade dysplasia will lead directly to esophageal cancer if not treated. The available treatments for high-grade dysplasia are generally the same as the treatments for low-grade dysplasia (cryotherapy, endoscopic resection, radiofrequency ablation), but your physician may also recommend surgery at this stage. Surgery would remove the damaged part of your esophagus and reconnect it with the stomach, without the damaged portion. 

After you receive endoscopic resection, radiofrequency ablation, or cryotherapy, you will schedule a follow-up endoscopy three to four months after treatment to ensure there is no dysplasia. It is also possible for Barrett’s esophagus to return after treatment. 

What Is the Outlook for Barrett’s Esophagus?

While the last stage of Barett’s esophagus is a precursor to cancer, the overall lifetime risk for one to get esophageal cancer from barett’s is about 5%. Regular testing is wise to ensure that dysplasia is not developing. Barrett’s esophagus can return after treatment, but your physician can treat it again and retest. Your gastroenterologist may also recommend not eating right before bedtime, skipping spicy and acidic foods, avoiding larger meals, quitting smoking, and limiting carbonated beverages and alcohol. These are all directives for lessening the symptoms of GERD.