Barrett's Esophagus

What is Barrett's Esophagus?

Barrett's esophagus is a change in the lining of the esophagus. These changes can occur from chronic reflux (flowing backward) of stomach contents.

What are the symptoms of Barrett's esophagus?

Barrett's esophagus does not cause signs or symptoms. Some patients with Barrett's esophagus may or may not experience heartburn, regurgitation or difficulty swallowing.

What are risk factors of developing Barrett's esophagus?

Chronic symptoms of gastroesophageal reflux disease
Obesity
Increasing age 50 years of age
Male
Caucasian
Smoking
Family history of Barrett's Esophagus

Diagnosis of Barrett's Esophagus

The way to confirm Barrett’s esophagus is through a procedure called an upper endoscopy. This involves inserting a tube with a camera and light on it into your mouth while under anesthesia. The doctor can see changes in the way your esophagus looks (Figure 1 and 2) and will take a small biopsy. Only the biopsy result will confirm if you have Barrett’s Esophagus.

Screening for Barrett’s esophagus may be considered in men with chronic (> 5 years) and/or frequent (weekly or more) symptoms of gastroesophageal reflux (heartburn or acid regurgitation) and two or more risk factors for Barrett’s esophagus or esophageal adenocarcinoma.

Screening of the general population is not recommended.

Treatment at Penn

How is Barrett's esophagus treated?

Treatment can include the use of certain medications that reduce acid reduction by the stomach. These include certain prescription medications known as proton pump inhibitors (PPIs) such as omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), esomeprazole (Nexium) and dexlansoprazole (Dexilant). Patients with Barrett's esophagus should receive once daily PPI therapy.

All patients with Barrett's esophagus in reasonably good health should undergo endoscopic surveillance at appropriate intervals. Talk to your physician to see what is appropriate for your care.

Lifestyle changes are also important in treating Barrett's esophagus. These include: not smoking and weight loss.

Patients with nodularity in the Barrett's esophagus segment should undergo endoscopic mucosal resection of the nodular lesion(s) as the initial diagnostic and therapeutic maneuver. Histologic assessment of the resection specimen should guide further therapy. In subjects with resection specimens demonstrating high grade dysplasia, or cancer, endoscopic ablative therapy of the remaining Barrett's esophagus segment should be performed.

In patients with dysplastic Barrett's esophagus who are to undergo endoscopic ablative therapy for non-nodular disease, radiofrequency ablation (RFA) is currently the preferred endoscopic ablative therapy.

What is radiofrequency ablation?

Radiofrequency ablation (RFA) therapy has been shown to be safe and effective for treating Barrett's esophagus. Radiofrequency energy (radio waves) is delivered via a catheter to the esophagus to remove diseased tissue while minimizing injury to healthy esophagus tissue. This is called ablation, which means the removal or destruction of abnormal tissue. While you are sedated, a device is inserted through the mouth into the esophagus and used to deliver a controlled level of energy and power to remove a thin layer of diseased tissue. Less than one second of energy removes tissue to a depth of about one millimeter. The ability to provide a controlled amount of heat to diseased tissue is one mechanism by which this therapy has a lower rate of complications than other forms of ablation therapy. Larger areas of Barrett's tissue are treated with the balloon-mounted catheter. Smaller areas are treated with the endoscope-mounted catheter. Both are introduced during an upper endoscopy procedure, which is a thin, flexible tube inserted through a patient's mouth.

What complications are associated with Barrett's esophagus?

Barrett's esophagus is a premalignant or precancerous condition that may lead to cancer of the esophagus. Currently, the risk of progressing to cancer is 0.1 to 0.5% each year. This cancer is called esophageal adenocarcinoma (Figure 3). Patients with Barrett's should have regular surveillance exams to detect cancer at an early potentially curable stage.

Research at Penn

Our large clinical population provides an extensive source of data for research. Currently, we are expanding our investigations and are looking for answers to these questions:

What causes Barrett's and how can it be prevented?
What role does genetics play in the disease?
How can we improve diagnosis and disease management techniques?