Barrett’s esophagus requires monitoring and treatment to decrease esophageal cancer risk

Mayo Clinic Q&A

Barrett's esophagus is a condition in which the lining esophagus becomes damaged by acid reflux, which causes the lining to thicken and become red. Over time, the valve between the esophagus and the stomach may begin to fail, leading to acid and chemical damage of the esophagus, a condition called gastroesophageal reflux disease, or GERD. In some people, GERD may trigger a change in the cells that line the lower esophagus, causing Barrett's esophagus.

"The stomach is well designed to handle highly acidic conditions," explains Dr. James East, a gastroenterologist at Mayo Clinic Healthcare in London. "But the esophagus is not designed to cope with acid. And so when acid comes up, that acid reflux damages the cells, replacing them with more acid-resistant cells that develop into Barrett's esophagus."

While frequent heartburn may be a sign, many people with Barrett’s esophagus have no symptoms. Having Barrett's esophagus does increase your risk of developing esophageal cancer. Although the cancer risk is small, it's important for people with Barrett's esophagus to have regular checkups to check for precancerous cells.

Those at highest risk for Barrett's esophagus include:

• White men over the age of 50.
• People with family history of Barrett's esophagus or esophageal cancer.
• People who smoke.
• People with excess abdominal fat.
• Patients with long-standing reflux lasting more than five years.

"If you have three of those risk factors, then you should have a screening endoscopy for Barrett's esophagus, according to current guidelines," says Dr. East.

To screen for Barrett's esophagus, a lighted tube with a camera at the end, called an endoscope, is passed down the throat to check for signs of changing esophagus tissue. A biopsy is often done to remove tissue and confirm the diagnosis.

Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health. Treatments in the early stages can include lifestyle measures and medications to help reduce acid reflux and therefore, the esophageal acid exposure.

If the cell damage is more extensive, radiofrequency ablation may be be used. In this technique, a balloon is used to heat the abnormal esophagus tissue and burn it away. Another technique, cryotherapy, applies cold liquid or gas to destroy the abnormal cells.

The best way to prevent Barrett's esophagus is to address acid reflux and GERD through lifestyle changes.

"Lifestyle measures that reduce the risk of reflux are the key here because once Barrett's esophagus develops, it's a permanent change unless we use some of the ablation techniques," says Dr. East. "So absolutely quit smoking, and limit alcohol and caffeine. And even losing a small amount of weight can really help reduce reflux symptoms."

On the Mayo Clinic Q&A podcast, Dr. East discusses diagnosing and treating Barrett’s esophagus.