Barrett’s esophagus is relatively common, affecting about 1-2% of the general population and up to 10-15% of individuals with chronic GERD. It is more frequently diagnosed in men than women and is most common in adults over 50 years old. The condition is also more prevalent in Caucasians compared to other racial groups. Rare forms of Barrett’s esophagus lead to development of esophageal cancer.

The primary cause of Barrett’s esophagus is chronic acid reflux from GERD. When stomach acid and bile repeatedly flow back into the esophagus, they irritate and damage the esophageal lining. Over time, this chronic irritation triggers cellular changes, leading to the replacement of normal squamous epithelium with columnar epithelium. Risk factors for Barrett’s esophagus include:

• Chronic GERD (most significant risk factor)

• Obesity, particularly abdominal obesity

• Smoking and excessive alcohol consumption

• Family history of Barrett’s esophagus or esophageal cancer

• Male sex and older age

Barrett’s esophagus itself does not cause symptoms, but it often coexists with GERD, which can cause:

• Frequent heartburn and acid reflux

• Regurgitation of stomach contents

• Difficulty swallowing (dysphagia)

• Chest pain or discomfort

• Chronic cough or hoarseness
  Many individuals with Barrett’s esophagus are asymptomatic and only discover the condition during an evaluation for GERD or other esophageal issues.

Barrett’s esophagus is diagnosed through an upper endoscopy with biopsy. The presence of columnar epithelium instead of normal squamous cells confirms the condition.

• Upper Endoscopy (Esophagogastroduodenoscopy, EGD): A flexible tube with a camera is used to visualize the esophagus and assess for tissue changes.

• Biopsy: Tissue samples are taken from the esophagus and examined under a microscope to confirm the presence of intestinal metaplasia and detect dysplasia (precancerous changes).

• Dysplasia Grading: Biopsies are classified into:

  • No dysplasia (low cancer risk)

  • Low-grade dysplasia (mild precancerous changes)

  • High-grade dysplasia (significant precancerous changes, requiring closer monitoring or treatment)

• pH Monitoring: In some cases, esophageal acid exposure is measured to assess GERD severity.

The treatment of Barrett’s esophagus focuses on controlling acid reflux and reducing the risk of progression to esophageal cancer:

• Lifestyle Modifications:

  • Avoiding trigger foods (spicy, acidic, or fatty foods)

  • Losing weight if overweight

  • Elevating the head of the bed to prevent nighttime reflux

  • Quitting smoking and limiting alcohol consumption

• Medications:

  • Proton pump inhibitors (PPIs): Medications like omeprazole and esomeprazole reduce stomach acid production, helping to prevent further damage.

  • H2 receptor blockers: Less potent acid reducers, sometimes used for milder cases.

• Endoscopic Surveillance:

  • Regular endoscopies with biopsies to monitor for progression, particularly in patients with dysplasia.

• Endoscopic Treatments for Dysplasia or Early Cancer:

  • Radiofrequency Ablation (RFA): Uses heat energy to remove abnormal tissue.

  • Endoscopic Mucosal Resection (EMR): Removes small areas of dysplastic tissue.

• Surgery (Esophagectomy): In rare cases of high-grade dysplasia or early-stage esophageal cancer, removal of part or all of the esophagus may be necessary.

The prognosis for Barrett’s esophagus is generally favorable, as the majority of individuals do not develop esophageal cancer. The estimated risk of progression to esophageal adenocarcinoma is about 0.3-0.5% per year. Regular monitoring and appropriate treatment can significantly reduce this risk. With proper management of GERD and lifestyle modifications, most patients can prevent complications and maintain a good quality of life. However, individuals with high-grade dysplasia require closer monitoring and may need endoscopic or surgical intervention to prevent cancer development.

1. Mayo Clinic - Barrett’s esophagus

2. Medline Plus - Barrett’s esophagus

3. Cleveland Clinic - Barrett’s esophagus