Approaching midlife? Be aware of Barrett’s esophagus, a risk factor for esophageal cancer
By Nicole Brudos Ferrara
A 2022 study from the University of Florida showed that rates of Barrett's esophagus, a risk factor for esophageal cancer, may be on the rise in adults ages 45 to 64. Barrett's esophagus is a condition in which the lining of the esophagus becomes damaged by acid reflux, causing the lining to thicken and become red.
"Barrett's esophagus is related to chronic acid damage from recurrent burning of the lower esophagus by acid reflux. Those damaged cells are pre-malignant and increase your risk of developing esophageal cancer," says James East, M.D., a Mayo Clinic gastroenterologist.
Dr. East explains what causes Barrett's esophagus, who is at risk, how it's diagnosed and treated, and what you can do to reduce your risk of developing the condition:
What causes Barrett's esophagus?
Barrett's esophagus mainly occurs in people with gastroesophageal reflux disease (GERD) symptoms. "Maybe 5% to 15% of those people have Barrett's esophagus," says Dr. East.
GERD occurs when the valve between the esophagus and the stomach, called the lower esophageal sphincter, begins to fail. "The ring of muscle at the bottom of the gullet compresses and stops the stomach's contents, which are acidic, from coming up into the esophagus," says Dr. East. Over time, if that valve is not fully working, the acid that escapes can lead to GERD and chemical damage to the esophagus.
GERD causes a range of symptoms. "Heartburn. Chest pain. People can sometimes have trouble swallowing or feel a lump in the throat," says Dr. East. "Some more unusual symptoms are chronic cough or worsening asthma." However, approximately half of the people diagnosed with Barrett's esophagus have no symptoms.
Who is at risk of Barrett's esophagus?
"Men have a greater risk of developing Barrett's esophagus than women — particularly white men over 50," says Dr. East. "Also, people with long-standing reflux of more than five years, people who smoke, are overweight, and have a family history of Barrett's esophagus or esophageal cancer."
If you have three or more of these risk factors, Dr. East says you should talk to your health care professional about a screening endoscopy for Barrett's esophagus.
How is Barrett's esophagus diagnosed?
Endoscopy is generally used to diagnose Barrett's esophagus. During this procedure, a care professional passes a lighted tube with a camera at the end down the throat to check for changes in the esophagus. Normal esophageal tissue is pale and glossy. Tissue with Barrett's esophagus is red and velvety.
"With modern, high-definition endoscopes, we can see where the bottom of the esophagus ends, and then we see darker red tongues of Barrett's esophagus extending up against the paler pink of the normal esophageal lining," says Dr. East.
If Barrett's esophagus is suspected, the health care professional performing your endoscopy will remove tissue for examination in the lab to confirm the diagnosis.
How is Barrett's esophagus treated?
Treatment for Barrett's esophagus will depend on the extent of abnormal cell growth in your esophagus and your overall health. If you don't have abnormal cell changes, known as dysplasia, your health care professional will usually recommend monitoring your condition and treating any GERD symptoms.
Lifestyle changes to ease symptoms are an important place to start, says Dr. East. "Stop smoking, reduce alcohol, try to lose some weight. These things will reduce reflux and esophageal acid exposure."
Medication to treat GERD also can reduce the amount of acid reaching your esophagus. "The aim is to completely abolish all reflux symptoms," says Dr. East. "The idea is that if we're not damaging the esophagus, we're not promoting that cell turnover that progresses toward cancer."
If abnormal cell changes are present, a health care professional may recommend treatments such as radiofrequency ablation, which uses heat to destroy abnormal tissue, or cryotherapy, which uses cold liquid or gas to freeze abnormal tissue. The tissue is allowed to warm up and then is frozen again. This cycle of freezing and thawing destroys the abnormal cells.
If your biopsy shows high-grade dysplasia, considered a precursor to esophageal cancer, you may consider surgery to remove the damaged part of your esophagus.
What can people do to prevent Barrett's esophagus?
You can reduce your risk of Barrett's esophagus and esophageal cancer. "Lifestyle measures that reduce the risk of reflux are key because once Barrett's esophagus develops, it's a permanent change unless we use some of the ablation techniques," says Dr. East.
Quit smoking. Eliminate foods and drinks that trigger heartburn, such as alcohol, coffee and chocolate. Eat more fruits and vegetables, and if you are overweight or obese, talk to your doctor about weight-loss strategies. "Losing even a small amount of weight can really help reduce reflux symptoms," says Dr. East.
Watch Dr. East discuss Barrett's esophagus in this "Mayo Clinic Q&A" podcast video: