Barrett’s esophagus is a condition closely related to gastroesophageal reflux disease (GERD). It affects about 1 in 10 patients with chronic acid reflux. When the lower part of the esophagus just outside the stomach is regularly exposed to acid reflux, the cells in that area can change. Eventually, they may look like the goblet cells that are found in the small intestine. While Barrett’s esophagus is a non-cancerous disease, patients who have it are at a significantly higher risk for esophageal cancer. Even though most patients with Barrett’s esophagus will not develop esophageal cancer, Barrett’s is considered a precancerous condition.
The gastroenterologists and surgeons at the Digestive Health Institute’s Mickle Center for Reflux and Esophageal Conditions see many patients with Barrett’s esophagus. Because of the high volume of Barrett’s patients they see, our doctors know how to provide the right level of care for this disease. Some patients find that their Barrett’s esophagus improves when they get their reflux symptoms under control. Others require an endoscopic procedure or, more rarely, surgery to remove the diseased cells from their esophagus. However mild or severe your Barrett’s esophagus is, at DHI’s Mickle Center, you will find the care you need to gain relief from acid reflux symptoms and reduce your esophageal cancer risk.
What Are the Symptoms of Barrett’s Esophagus?
By itself, Barrett’s esophagus does not cause symptoms. However, because it is commonly caused by chronic acid reflux, patients with Barrett’s esophagus tend to have symptoms of GERD.
GERD symptoms include:
- Frequent heartburn or chest pain, experienced as a burning pain in the lower part of the middle of the chest and in the mid-abdomen
- Dry cough
- Asthma symptoms
- A bitter taste in the mouth or back of the throat
- Difficulty swallowing
How Is Barrett’s Esophagus Diagnosed?
Certain patients with GERD should be screened for Barrett’s esophagus. Screening is done with an upper endoscopy, where a light and camera are placed on an endoscope down into the esophagus. The endoscope will also remove cells from the esophagus for biopsy. Looking at the genetic makeup of these cells under a microscope can confirm a diagnosis of Barrett’s esophagus.
Screening is usually for patients who have at least two risk factors for Barrett’s esophagus, which include:
- A history of gastroesophageal reflux disease (GERD)
- Being overweight
- Having a hiatal hernia
- Being male
- Being age 50 or older
Esophageal Cancer Screening
If you are diagnosed with Barrett’s esophagus, there is a chance that the changed cells in your esophagus could become cancer. Your gastroenterologist may recommend that you have routine screenings for esophageal cancer. These will be done with the same endoscopic procedure used to diagnose Barrett’s esophagus. If you develop esophageal cancer, regular screenings will help ensure that it is caught at an early stage, and will likely make cancer treatment easier and more effective.
What Is the Treatment for Barrett’s Esophagus?
The first step in treating Barrett’s esophagus is to get your acid reflux symptoms under control. The Mickle Center’s doctors focus on treating GERD. Oftentimes, patients find relief from a minimally invasive surgery performed at DHI that cures GERD symptoms. In turn, this lowers their risk for esophageal cancer. For more information on permanent treatments for GERD, see our web page on GERD & Acid Reflux Treatment.
If Barrett’s esophagus is in more advanced stages, treatment for the diseased esophageal lining may be needed.
At DHI, direct treatment for Barrett’s esophagus is usually done in one of three ways:
Thermal Ablation for Barrett’s Esophagus
Thermal ablation is a non-invasive procedure. It involves using an endoscope to directly apply heat generated by radio frequency ablation (RFA) to the diseased area. The heat burns off the Barrett’s cells in the lining of the esophagus.
No incision is required since the physician accesses the area through the esophagus itself. After thermal ablation, patients will need to undergo an anti-reflux operation to prevent the recurrence or progression of Barrett's esophagus.
Benefits of thermal ablation include:
- A shorter recovery time compared to other treatment techniques for Barrett’s esophagus
- No surgical incisions because the doctor uses an endoscope that is inserted through the mouth and down into the affected area of the esophagus
- No need for hospitalization because thermal ablation is an outpatient procedure
Endoscopic Mucosal Resection (EMR) for Barrett’s Esophagus
EMR is another endoscopic procedure used to treat Barrett’s esophagus. Through the endoscope, the doctor is able to use instruments that cut away the diseased lining of the esophagus. Unlike thermal ablation which does not involve incisions, with EMR the doctor has to make internal incisions to cut out tissue. However, this treatment does not involve external incisions, which means recovery time is relatively short. As with thermal ablation, to prevent the recurrence or progression of Barrett's esophagus, patients will require an anti-reflux operation after EMR.
Robotic Transhiatal Esophagectomy
In some cases, when Barrett’s esophagus progresses to esophageal cancer, treatment by removing part of the esophagus may be in order. While esophagectomy is a major operation, Mickle Center surgeons Dr. Sharona Ross and Dr. Alexander Rosemurgy are experienced in offering it in minimally invasive ways. Minimally invasive esophagectomy, or robotic transhiatal esophagectomy, results in smaller external scars and faster recoveries.