What is Barrett’s esophagus?
Barrett’s esophagus is a change to the lining of the esophagus (the tube connecting your mouth to your stomach). These changes happen in a small number of patients with chronic gastroesophageal reflux disease (GERD). Barrett’s esophagus is a change from one type of cell to another and does not cause any symptoms. Over time, there can be changes within the cells (dysplasia) that increase the risk of developing one type of cancer in the esophagus called adenocarcinoma.
GERD is common, but most people with GERD do not get Barrett’s esophagus. Tobacco use and being overweight are important risks for developing Barrett’s esophagus. Most people with Barrett’s esophagus do not get cancer, but because the risk is higher than for people without Barrett’s esophagus, it is recommended to monitor for changes over time.
Understanding your diagnosis
The diagnosis and monitoring of Barrett’s esophagus is done with upper endoscopy, a test using a flexible tube with a camera to look into your esophagus. A biopsy (small tissue sample) is taken and examined under a microscope to look for changes in the number, size, shape, or organization of cells.
Depending on how the cells look, you may hear these terms:
| Diagnosis | What it means | Risk of cancer |
|---|---|---|
|
Nondysplastic BE (NDBE) |
The cells have changed to Barrett’s, but there are no signs of dysplasia |
Very low |
|
Indefinite for dysplasia (IND) |
The cells have changed, which could be due to inflammation (swelling) or the beginning of important changes (dysplasia) |
Unclear |
|
Low-grade dysplasia (LGD) |
The Barrett’s cells have changed, and the risk of turning into cancer is higher |
Moderate |
|
High-grade dysplasia (HGD) |
The Barrett’s cells are even more abnormal, and the risk of cancer is even higher |
High |
It is important to know that dysplasia is not cancer, but does increase the risk of cancer in the future. Many people with dysplasia in their Barrett’s esophagus undergo endoscopic treatment.
Some people have a short segment of Barrett’s esophagus. If your Barrett’s esophagus is less than 1 cm in length, around the size of a pea, new guidelines from the American Gastroenterological Association (AGA) suggest against regular endoscopy for monitoring.
What are my treatment options?
AGA’s guidelines offer different treatment recommendations based on your diagnosis.
All patients with Barrett’s esophagus should take medicine to treat reflux disease at least once a day, regardless of whether you have symptoms or not. Proton pump inhibitors lessen your risk of developing cancer from Barrett’s. Surgery to treat reflux disease does not lower your risk of cancer.
Here’s a breakdown:
What’s recommended
- No active treatment to remove the Barrett’s tissue is needed.
- Instead, surveillance endoscopy with biopsies is recommended every 3 to 5 years to monitor for changes depending on the length of your Barrett’s segment.
Why not treat it now
- The risk of cancer is so low that treatment does not reduce the risk.
Other possible evaluation
- Along with biopsies, your doctor may choose to get additional samples with WATS-3D brushing from your Barrett’s.
- Other biomarker testing such as p53 and TissueCypher may be used to help your doctor with predicting your disease course.
What’s recommended?
- First, improve acid control—your doctor may increase your PPI to a higher dose.
- Then, repeat your endoscopy within 6 months to get a clearer diagnosis.
Why?
- You might not actually have dysplasia. Treating inflammation first helps ensure a more accurate diagnosis later.
What’s recommended?
- AGA suggests treatment with endoscopy to remove the abnormal tissue.
- If you prefer not to have treatment, close surveillance (repeat endoscopies in 6 months, then every 12 months) is an option.
- Please talk to your doctor about what the best option would be for you.
Why treat now?
- Low-grade dysplasia can progress to high-grade dysplasia or cancer. Treatment lowers that risk significantly and is a safe, effective option.
What’s recommended?
- AGA strongly recommends treatment with endoscopy to remove these cells.
- The goal is to remove dysplasia before it becomes cancer AND to avoid future surgery for cancer.
Why treat now?
- High-grade dysplasia has a much higher risk of becoming cancer, sometimes within a year or two.
What is endoscopic eradication therapy?
Endoscopic eradication therapy is a non-surgical way to remove or destroy abnormal tissue using upper endoscopy.
It may include:
- Endoscopic resection (ER)
- Used to remove visible lesions or raised areas.
- These spots may already have dysplasia or early cancer.
- Radiofrequency ablation (RFA)
- Uses controlled heat to burn away the Barrett’s lining.
- Cryotherapy
- Uses extreme cold to freeze and destroy abnormal cells.
After endoscopic eradication therapy, the healthy tissue usually grows back as normal esophageal lining. Patients typically need three to four endoscopic eradication therapy treatments every two to three months until all the Barrett’s is cleared.
What happens after treatment?
Even after treatment, there’s a chance Barrett’s or dysplasia can come back. That’s why follow-up is so important.
You will need to continue taking acid-blocking medicine to prevent damage to the new tissue.
You will still need to have a monitoring endoscopy at regular time points after endoscopic treatment:
| Diagnosis | Surveillance schedule |
|---|---|
|
Low-grade dysplasia (LGD) |
12 months after Barrett’s clearance and then every three years after that |
|
High-grade dysplasia (HGD) or early cancer |
Every 3 to 6 months in the first year after Barrett’s clearance, and then every 12 months after that |
1. How much Barrett’s do I have? Does this require monitoring or surveillance?
2. Do I have dysplasia? What type of dysplasia?
3. What are the risks of doing treatment vs. monitoring?
4. How experienced is my care team with EET?
5. What can I do to lower my risk of cancer?
Other things you can do
Most people with Barrett’s esophagus, even those with dysplasia, do not die from esophageal cancer. They are much more likely to die from heart disease, lung disease, or stroke. If you use tobacco or are overweight, you should quit using tobacco and lose weight to decrease the risks of those diseases.
Take-home messages
- Most people with Barrett’s esophagus have a low risk of developing cancer, but monitoring and treatment are important for those at higher risk.
- Endoscopic treatment is safe and effective at preventing cancer in people with dysplasia.
- Endoscopic treatment is not recommended in patients without dysplasia.
- Work with a specialist in Barrett’s esophagus care for the best outcomes.
- Don’t forget follow-up care — even after treatment, regular checks are key.
WRITTEN BY
Swathi Eluri, MD, MSCR
Mayo Clinic, Jacksonville, FL
David A. Leiman, MD, MSHP
Duke University School of Medicine, Durham, NC
Joel H. Rubenstein, MD, MSc
University of Michigan School of Medicine, Ann Arbor, MI