Barrett’s Esophagus – Diagnosis and Treatment
Diagnosis
Doctors often use an upper endoscopy to look inside the esophagus. They move a thin, flexible tube with a camera down the throat.
This tool lets the doctor see the lining of the esophagus up close. Healthy tissue appears pale and glossy. In Barrett’s esophagus, the lining looks red and has a velvety texture.
Doctors usually take a biopsy during the procedure. They remove a small piece of tissue and send it to a lab.
A pathologist examines the cells under a microscope to look for unusual changes. Sometimes, two pathologists, including a gastrointestinal expert, review the tissue to make sure the results are correct.
The tissue samples fit into three main groups:
| Category | Description |
|---|---|
| No changes (No dysplasia) | The cells look normal, even if Barrett’s tissue is present. |
| Mild changes (Low-grade) | Some cells show small, early changes that might lead to cancer later. |
| Major changes (High-grade) | Many cells have clear signs that they might turn into cancer soon. |
Who Should Get Checked for Barrett’s Esophagus
Doctors screen certain people who are at higher risk. Men who have heartburn or acid reflux (GERD) at least once a week and do not improve with medication may need screening, especially if they have two or more risk factors:
- Family history of Barrett’s esophagus or esophageal cancer
- Male gender
- White race
- Age over 50 years
- Current or former smoker
- Extra belly fat
Screening is less common for women. However, women with ongoing reflux that does not improve, or who have other risk factors, may need testing. People with symptoms or risk factors should talk with their doctor about screening.
Treatment
When There Are No Abnormal Cells
People with Barrett’s esophagus but no cell changes need regular checks. Doctors recommend routine endoscopy to watch for new changes.
The first check happens about one year after diagnosis. If things are stable, follow-ups are every three to five years.
Doctors also focus on managing acid reflux symptoms. They may suggest medicines to lower stomach acid, lifestyle changes to reduce reflux, or sometimes procedures to fix a weak valve at the bottom of the esophagus.
Sometimes, doctors repair a hiatal hernia if needed.
Tips for mild cases:
- Eat smaller meals
- Avoid food triggers
- Elevate the head of the bed
- Stop tobacco use
- Limit alcohol
Early Changes in the Esophageal Lining
Low-level, or early cell changes, may require more frequent checks. If a pathologist confirms mild dysplasia, doctors often schedule another endoscopy about six months later.
Extra checks usually happen every six to twelve months.
Because the risk of cancer is higher over time, doctors may recommend treatments such as:
Endoscopic Procedures
| Treatment | Purpose |
|---|---|
| Endoscopic resection | Removes problem areas for closer viewing |
| Radiofrequency ablation | Uses heat to destroy faulty cells |
| Cryotherapy | Freezes and thaws cells to damage them |
If the esophagus is inflamed, doctors treat the irritation first for three to four months before checking again.
Serious Cell Changes in the Esophagus
Severe changes, called high-grade dysplasia, make cancer more likely. Doctors use endoscopic resection, radiofrequency ablation, and cryotherapy to remove or destroy abnormal tissue.
Sometimes, surgery is needed. The most common surgery removes the damaged part of the esophagus and connects the rest to the stomach.
Doctors continue to monitor patients because Barrett’s esophagus can return after treatment. If surgery is not done, lifelong acid-lowering medicine is usually recommended.
Ways to Manage Symptoms at Home
Simple steps at home can help reduce discomfort. Keeping a healthy weight and avoiding foods like chocolate, coffee, alcohol, and mint may prevent heartburn.
Quitting smoking supports overall health. Raising the head of the bed with sturdy blocks may also help with nighttime symptoms.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
- Follow Pre-Visit Rules: Some appointments require not eating solid food the day before. Check any instructions from the clinic.
- List All Symptoms: Write down every symptom, even minor ones or those that seem unrelated.
- Prepare a Medication List: Include all current medications, vitamins, and supplements.
- Gather Medical Details: Note any other health conditions or important medical information.
- Bring a Support Person: A friend or family member can help remember details or ask questions.
- Create a Question List: Put together questions you want to discuss with the doctor.
Sample Table: Important to Bring
| Item | Reason |
|---|---|
| Symptom notes | Give complete info to doctor |
| Medication list | Avoid harmful drug interactions |
| Medical records/summaries | Show previous care and diagnoses |
| Insurance card | For registration and billing |
| Questions to ask | Help guide the discussion |
Points to Discuss With Your Specialist
- Is there any sign of early changes that could become cancer?
- How much of the food pipe is affected?
- How often should screening take place?
- Are test results reviewed by expert pathologists?
- What is the risk of developing cancer?
- What treatment steps are recommended?
- Are diet or lifestyle changes needed?
- How should other health problems be managed with Barrett’s esophagus?
Tip: Patients can always ask more questions during the meeting, even if they were not planned in advance.
Common Questions From Your Healthcare Provider
The doctor will likely ask questions to understand the situation better.
- They may ask when your symptoms started and how severe they are.
- They might want to know if symptoms come and go, or if they are always present.
- You may be asked what things make symptoms better or worse.
- The doctor could ask if you have signs of acid reflux, like heartburn.
- They may ask if you need any medicine for indigestion or reflux.
- You might be asked if swallowing is ever difficult.
- The doctor could also ask if you have had any unexplained weight changes.
