Barrett's Esophagus

The esophagus is a muscular tube that carries food and liquids from the back of the mouth to the stomach, and is lined with squamous epithelium. When injured by acid reflux, the squamous lining is replaced by tissue similar to that normally found in the intestine. This process, known as intestinal metaplasia, is the body’s way of healing.

Who Develops Barrett’s Esophagus?

Approximately 10-15% of people with GERD symptoms develop Barrett’s Esophagus. It affects approximately 700,000 adults in the United States, or 1 in 500 of the general Caucasian population, especially white males. Barrett’s esophagus may run in some families. There are ongoing studies to determine if any genes or markers can be found in families.

How Is It Diagnosed?

Barrett’s Esophagus can only be diagnosed by an upper GI endoscopic examination. During upper endoscopy, the metaplastic area is seen by the gastroenterologist as an abnormal pink to salmon color instead of the normal whitish lining of the esophagus. It should be above the EG junction, usually less than 2.5 inches. The biopsy of this abnormal lining, is examined under a microscope by a pathologist and must show goblet cell type of intestinal metaplasia to be considered Barrett’s Esophagus.

Recommendations for Follow-up Endoscopy for Barrett’s Esophagus:

The American College of Gastroenterology recommends systematic biopsies to document Barrett’s Esophagus and to detect dysplasia. The grade of dysplasia is determined by the pathologist and dictates the follow-up interval.

  • After two yearly examinations with biopsies negative for dysplasia, endoscopic re-examination can be extended to two to three year intervals.
  • With low grade dysplasia, the interval for re-examination is six months to one year.
  • High grade dysplasia requires immediate repeat endoscopy with multiple biopsies to rule out cancer and confirm the high grade dysplasia.
  • Patients with focal high grade dysplasia should be checked every three months with endoscopy and biopsy. Extensive high grade dysplasia or cancer requires an intervention, such as: surgery, laser ablation, photo dynamic therapy or endoscopic mucosal resection, as recommended by the physician.

Cancer of the Esophagus

Barrett’s Esophagus is associated with an increase risk of developing an invasive cancer, adenocarcinoma. Patients with Barrett’s esophagus have an increased risk, as compared with the general population. The disease is most common in white males. Black males do not present with Barrett’s Esophagus, the precursor lesion, but have an increased incidence of adenocarcinoma of the esophagus as well. Since there is a sequence of changes in Barrett’s esophagus from intestinal metaplasia to low grade dysplasia and high grade dysplasia, early detection and treatment can prevent cancer.