Barrett’s Esophagus

Barrett’s Esophagus (or Columnar-Lined Esophagus) is a precancerous condition involving the lining of the esophagus. The esophagus is normally lined with squamous epithelium, while the stomach is lined with columnar epithelium. The interface between the two makes up the squamocolumnar junction.

Chronic reflux can cause a transformation of the lower part of the esophageal lining from the normal squamous epithelium to a lining that appears more like that of the stomach (columnar). It is not exactly like the stomach lining, however, and “intestinal metaplasia” with very specific microscopic findings must be present to call it Barrett’s esophagus. This can sometimes be difficult to differentiate from hiatal hernia, so biopsy is always required for the diagnosis.

Barrett’s esophagus is considered a pre-malignant condition, because the risk of a certain type of esophageal cancer (esophageal adenocarcinoma) typically occurs in an area of pre-existing Barrett’s. Esophageal adenocarcinoma is very rare, but the incidence is increasing in the US at a faster rate than any other cancer! Early diagnosis is key, and that’s why we think finding Barrett’s esophagus is important. Biopsies will tell us if the cells have actually started to resemble cancer cells (dysplasia). If you have Barrett’s esophagus, your risk of getting esophageal cancer is still very low – but it’s about 30-300 times higher than the general population. The risk of cancer goes up in the presence of dysplasia.

A lot of debate exists about how to follow people with Barrett’s esophagus, but most esophagus specialists recommend endoscopy every 1-3 years in people who have Barrett’s esophagus to rule out dysplasia and look for small cancers. Treating reflux disease probably helps prevent the progression of Barrett’s esophagus to cancer, but in general, Barrett’s esophagus does not go away once you have it.

The rate of Barrett’s esophagus may be as high in people with laryngopharyngeal reflux symptoms as it in people with heartburn and regurgitation. Therefore, if you have reflux disease of any type, we recommend a screening esophagoscopy in the office. Biopsies (which are very small and do not cause pain) can easily be performed during this office procedure.