ConditionDigestive system
Barrett's Esophagus
Barrett's esophagus is a condition in which the normal lining of the lower esophagus is replaced by tissue that looks like intestinal lining, usually after years of acid reflux. It causes no symptoms of its own. It matters because it slightly raises the risk of esophageal adenocarcinoma, so doctors control reflux and check the lining with regular endoscopy. Most people with Barrett's never develop cancer.
Also called: Barrett esophagus, Barrett's esophagus, columnar-lined esophagus, intestinal metaplasia of the esophagus
At a glance
- What it is
- Acid-damaged lining of the lower esophagus that has changed into a more acid-resistant, intestine-like lining (intestinal metaplasia).
- Cause
- Long-standing gastroesophageal reflux disease (GERD).
- Symptoms
- None from Barrett's itself. People usually notice reflux symptoms such as heartburn.
- Cancer risk
- Low without dysplasia, roughly 0.1% to 0.3% per year. Higher if dysplasia is found.
- Diagnosis
- Upper endoscopy with biopsies.
- Treatment
- Acid-suppressing medicine, endoscopic surveillance, and ablation or resection for dysplasia.
When to get help
Call 911 or go to the ER
- Vomiting blood or material that looks like coffee grounds
- Black, tarry stools with dizziness or fainting
- Food stuck in the chest with inability to swallow saliva
- Crushing or squeezing chest pain, which must be checked for a heart attack first
See a doctor within a day or two
- Food sticking when you swallow, or swallowing that is getting harder over weeks
- Unintended weight loss, persistent vomiting or new anemia
- Pain when swallowing
Book a routine appointment
- Heartburn or reflux more than twice a week, or for 5 years or more, especially in men over 50 or people with other risk factors
- Reflux that persists despite over-the-counter medicine
- Missed or overdue Barrett's surveillance endoscopy
Usually safe to manage at home
- Occasional heartburn after large or late meals, with no warning signs, while you work on weight, meal timing and trigger foods
What happens in Barrett's esophagus
The esophagus is normally lined with flat, tough cells (squamous cells). In gastroesophageal reflux disease, stomach acid and bile wash up into the lower esophagus repeatedly. Over years, the lining can heal by replacing squamous cells with column-shaped, mucus-making cells similar to those in the intestine. This change is called intestinal metaplasia, and when it extends at least 1 cm above the junction with the stomach, it is Barrett's esophagus.
The new lining resists acid better, which may be why many people with Barrett's notice their heartburn easing. But the cells are less stable. In a small number of people they slowly progress through stages:
| Stage | What the pathologist sees | What it means |
|---|---|---|
| Non-dysplastic Barrett's | Intestinal metaplasia, normal-looking cells | Lowest risk. Surveillance every 3 to 5 years |
| Indefinite for dysplasia | Changes that could be inflammation or early dysplasia | Treat reflux intensively, repeat biopsy |
| Low-grade dysplasia | Mildly abnormal cells, confirmed by a second pathologist | Endoscopic ablation is usually offered |
| High-grade dysplasia | Markedly abnormal precancerous cells | Endoscopic treatment is recommended |
| Adenocarcinoma | Cancer | Endoscopic or surgical treatment depending on depth |
Symptoms
Barrett's esophagus does not cause symptoms. Most people are diagnosed when they have an endoscopy for reflux. The symptoms you may have come from reflux:
- Heartburn: burning behind the breastbone, worse after meals or lying down
- Acid or food coming back into the mouth (regurgitation)
- Chronic cough, hoarseness or a sour taste in the morning
- Difficulty swallowing, which can mean a narrowing (stricture) or, less often, cancer
Causes and risk factors
GERD is the main cause. The risk of Barrett's is higher with:
- Reflux symptoms for 5 years or more
- Male sex (men are 2 to 3 times more likely to have it)
- Age 50 or older
- White race
- Central obesity (fat around the waist)
- Current or past smoking
- A hiatal hernia
- A parent or sibling with Barrett's or esophageal adenocarcinoma
Some people with Barrett's have never had noticeable heartburn.
Diagnosis and screening
Diagnosis requires an upper endoscopy: a thin camera passed through the mouth under sedation. Barrett's lining looks salmon-pink compared with the pale pink normal lining. The doctor measures its length and takes biopsies in a systematic pattern (four-quadrant biopsies every 1 to 2 cm). A pathologist confirms intestinal metaplasia and looks for dysplasia.
US guidelines suggest a single screening endoscopy for people with chronic reflux plus three or more risk factors from the list above. A swallowed capsule sponge test is an alternative screening method in some centers.
Treatment
Controlling reflux
- A proton pump inhibitor (PPI) taken once daily is recommended for everyone with Barrett's, both to control symptoms and to heal inflammation that can blur biopsy results.
- Lifestyle measures: lose weight if overweight, stop smoking, avoid eating within 3 hours of bed and raise the head of the bed.
- Anti-reflux surgery (fundoplication) controls reflux in selected people but has not been shown to prevent cancer better than medicine.
Surveillance endoscopy
For non-dysplastic Barrett's, repeat endoscopy is usually advised every 3 to 5 years, depending on the length of the segment. The aim is to catch dysplasia, which is treatable, before it becomes cancer.
Endoscopic eradication therapy
For confirmed dysplasia or very early cancer, the abnormal lining is removed without surgery:
- Endoscopic mucosal resection (EMR): cuts out visible nodules for treatment and accurate staging.
- Radiofrequency ablation (RFA): a balloon or paddle delivers heat that destroys the Barrett's lining, which regrows as normal squamous lining.
- Cryotherapy: freezes abnormal tissue.
After eradication, surveillance continues, because Barrett's can recur.
Complications
- Esophageal adenocarcinoma: the main concern, though the absolute risk is low without dysplasia.
- Ulcers and bleeding in the Barrett's segment.
- Esophageal stricture: scarring that narrows the esophagus and makes food stick.
Outlook
Most people with Barrett's esophagus live a normal lifespan and die of unrelated causes. Good reflux control and keeping to surveillance schedules are what matter most. If esophageal cancer does develop in someone under surveillance, it is usually found at an early, curable stage.
Frequently asked questions
What are the symptoms of Barrett's esophagus?
Barrett's esophagus has no symptoms of its own. People usually have reflux symptoms such as heartburn, regurgitation or a sour taste. Trouble swallowing, weight loss or vomiting blood are warning signs that need prompt medical review.
Does Barrett's esophagus always turn into cancer?
No. Most people never develop cancer. Without dysplasia, the yearly risk is around 0.1% to 0.3%, or about 1 in 300 to 1 in 1,000 per year. The risk rises if dysplasia develops, which is why regular endoscopy is recommended.
Can Barrett's esophagus go away?
Acid-suppressing medicine controls reflux but rarely makes Barrett's lining disappear. Endoscopic ablation can remove it and is used when dysplasia is present. Even after successful ablation, follow-up endoscopies are needed because it can come back.
How often do I need an endoscopy with Barrett's esophagus?
For Barrett's without dysplasia, typically every 3 years for segments 3 cm or longer and every 5 years for shorter segments, per US guidance. Dysplasia, or a history of treatment, requires more frequent checks set by your gastroenterologist.
What should I avoid with Barrett's esophagus?
Avoid smoking, large late meals and lying down soon after eating. Limit foods and drinks that trigger your reflux, often alcohol, fatty meals, chocolate, coffee and spicy food. Losing excess weight around the waist reduces reflux.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Gastroenterology: Diagnosis and Management of Barrett's Esophagus (2022 guideline)
- American Gastroenterological Association: Clinical Practice Update on Screening and Surveillance in Barrett's Esophagus
- NIDDK: Barrett's Esophagus
- NHS: Barrett's oesophagus
- British Society of Gastroenterology: Guidelines on the diagnosis and management of Barrett's oesophagus