Barrettes Esophagus

Endoscopy is generally used to determine if you have Barrett's esophagus.

A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing esophagus tissue. Normal esophagus tissue appears pale and glossy. In Barrett's esophagus, the tissue appears red and velvety.

Your doctor will remove tissue (biopsy) from your esophagus. The biopsied tissue can be examined to determine the degree of change.

Determining the degree of tissue change

A doctor who specializes in examining tissue in a laboratory (pathologist) determines the degree of dysplasia in your esophagus cells. Because it can be difficult to diagnose dysplasia in the esophagus, it's best to have two pathologists — with at least one who specializes in gastroenterology pathology — agree on your diagnosis. Your tissue may be classified as:

No dysplasia, if Barrett's esophagus is present but no precancerous changes are found in the cells.

Low-grade dysplasia, if cells show small signs of precancerous changes.

High-grade dysplasia, if cells show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.

Screening for Barrett's esophagus

Endoscopy view of Barrett's esophagus

Barrett's esophagus diagnosisOpen pop-up dialog box

The American College of Gastroenterology says screening may be recommended for men who have had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:

Having a family history of Barrett's esophagus or esophageal cancer

Being male

Being white

Being over 50

Being a current or past smoker

Having a lot of abdominal fat

Treatment for Barrett's esophagus depends on the extent of abnormal cell growth in your esophagus and your overall health.

No dysplasia

Your doctor will likely recommend:

Periodic endoscopy to monitor the cells in your esophagus. If your biopsies show no dysplasia, you'll probably have a follow-up endoscopy in one year and then every three to five years if no changes occur.

Treatment for GERD. Medication and lifestyle changes can ease your signs and symptoms. Surgery or endoscopy procedures to correct a hiatal hernia or to tighten the lower esophageal sphincter that controls the flow of stomach acid may be an option.

Low-grade dysplasia

Low-grade dysplasia is considered the early stage of precancerous changes. If low-grade dysplasia is found, it should be verified by an experienced pathologist. For low-grade dysplasia, your doctor may recommend another endoscopy in six months, with additional follow-up every six to 12 months.

But, given the risk of esophageal cancer, treatment may be recommended if the diagnosis is confirmed. Preferred treatments include:

Endoscopic resection, which uses an endoscope to remove damaged cells to aid in the detection of dysplasia and cancer.

Radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.

Cryotherapy, which uses an endoscope to apply a cold liquid or gas to abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the abnormal cells.

If significant inflammation of the esophagus is present at initial endoscopy, another endoscopy is performed after you've received three to four months of treatment to reduce stomach acid.

High-grade dysplasia

Nissen fundoplication 

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High-grade dysplasia is generally thought to be a precursor to esophageal cancer. For this reason, your doctor may recommend endoscopic resection, radiofrequency ablation or cryotherapy. Another option may be surgery, which involves removing the damaged part of your esophagus and attaching the remaining portion to your stomach.

Recurrence of Barrett's esophagus is possible after treatment. Ask your doctor how often you need to come back for follow-up testing. If you have treatment other than surgery to remove abnormal esophageal tissue, your doctor is likely to recommend lifelong medication to reduce acid and help your esophagus heal.