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Barrett's esophagus is a condition in which the esophagus, the
muscular tube that carries food and saliva from the mouth to the
stomach, changes so that some of its lining is replaced by a type of
tissue similar to that normally found in the intestine. This process
is called intestinal metaplasia.
While Barrett's esophagus may cause no symptoms itself, a small
number of people with this condition develop a relatively rare but
often deadly type of cancer of the esophagus called esophageal
adenocarcinoma. Barrett's esophagus is estimated to affect about
700,000 adults in the United States. It is associated with the very
common condition gastroesophageal reflux disease or GERD.
The esophagus seems to have only one important function in the
body--to carry food, liquids, and saliva from the mouth to the
stomach. The stomach then acts as a container to start digestion and
pump food and liquids into the intestines in a controlled process.
Food can then be properly digested over time, and nutrients can be
absorbed by the intestines.
The esophagus transports food to the stomach by coordinated
contractions of its muscular lining. This process is automatic and
people are usually not aware of it. Many people have felt their
esophagus when they swallow something too large, try to eat too
quickly, or drink very hot or very cold liquids. They then feel the
movement of the food or drink down the esophagus into the stomach,
which may be an uncomfortable sensation.
The muscular layers of the esophagus are normally pinched
together at both the upper and lower ends by muscles called
sphincters. When a person swallows, the sphincters relax
automatically to allow food or drink to pass from the mouth and into
the stomach. The muscles then close rapidly to prevent the swallowed
food or drink from leaking out of the stomach back into the
esophagus or into the mouth. These muscles make it possible to
swallow while lying down or even upside-down. When people belch to
release swallowed air or gas from carbonated beverages, the
sphincters relax and small amounts of food or drink may come back up
briefly; this condition is called reflux. The esophagus quickly
squeezes the material back into the stomach, and this is considered
While these functions of the esophagus are obviously an important
part of everyday life, people who must have their esophagus removed,
for example because of cancer, can live a relatively healthy life
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Having liquids or gas occasionally reflux is considered normal.
When it happens frequently, particularly when not trying to belch,
and causes other symptoms, then it is considered a medical problem
or disease. However, it is not necessarily a serious one or one that
requires seeing a physician.
The stomach produces acid and enzymes to digest food, and when
this mixture refluxes into the esophagus more frequently than normal
or for a longer period of time than normal, it may produce symptoms.
These symptoms, often called acid reflux, are usually described by
people as heartburn, indigestion, or "gas." The symptoms typically
consist of a burning sensation below and behind the lower part of
the breastbone or sternum.
Almost everyone has experienced these symptoms at least once,
typically as a result of overeating. Other things that provoke GERD
symptoms include being overweight, eating certain types of foods, or
being pregnant. In most people, GERD symptoms may last only a short
time and require no treatment at all. More persistent symptoms are
often quickly relieved by over-the-counter acid-reducing agents such
as antacids. Common antacids are
Other drugs used to relieve GERD symptoms are antisecretory drugs
such as histamine2 (H2) blockers or proton pump
inhibitors. Common H2 blockers are
- cimetidine (Tagamet HB)
- famotidine (Pepcid AC)
- nizatidine (Axid AR)
- ranitidine (Zantac 75)
Common proton pump inhibitors are
- esomeprazole (Nexium)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- pantoprazole (Protonix)
- rabeprazole (Aciphex)
People who have symptoms frequently should consult a physician.
Other diseases can have similar symptoms, and prescription
medications in combination with other measures might be needed to
reduce reflux. GERD that is untreated over a long period can lead to
complications, such as an ulcer in the esophagus that could cause
bleeding. Another common complication is scar tissue that blocks the
movement of swallowed food and drink through the esophagus; this
condition is called stricture.
Esophageal reflux may also cause certain less common symptoms,
such as hoarseness or chronic cough, and sometimes provokes
conditions such as asthma. While most patients find that lifestyle
modifications and acid-blocking drugs relieve their symptoms,
doctors occasionally recommend surgery. Overall, GERD is one of the
most common medical conditions. Some 20 percent of the population
can be affected over a lifetime.
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The exact causes of Barrett's esophagus are not known, but it is
thought to be caused in part by the same factors that cause GERD.
Although people who do not have heartburn can have Barrett's
esophagus, it is found about three to five times more often in
people with this condition.
Barrett's esophagus is uncommon in children. The average age at
diagnosis is 60, but it is usually difficult to determine when the
problem started. It is about twice as common in men as in women and
much more common in white men than in men of other races.
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Barrett's esophagus does not cause symptoms itself and is
important only because it seems to precede the development of a
particular kind of cancer--esophageal adenocarcinoma. The risk of
developing adenocarcinoma is 30 to 125 times higher in people who
have Barrett's esophagus than in people who do not. This type of
cancer is increasing rapidly in white men. The increase is possibly
related to the rise in obesity and GERD.
For people who have Barrett's esophagus, the risk of getting
cancer of the esophagus is small: less than 1 percent (0.4 percent
to 0.5 percent) per year. Esophageal adenocarcinoma is often not
curable, partly because the disease is frequently discovered at a
late stage and because treatments are not effective.
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Diagnosing Barrett's esophagus is not easy. At the present time,
it cannot be diagnosed on the basis of symptoms, physical exam, or
blood tests. The only useful test is upper gastrointestinal
endoscopy and biopsy. In this procedure, a flexible tube called an
endoscope, which has a light and miniature camera, is passed into
the esophagus. If the tissue appears suspicious, then biopsies must
be done. A biopsy is the removal of a small piece of tissue using a
pincher-like device passed through the endoscope. A pathologist
examines the tissue under a microscope to confirm the diagnosis.
Looking for a medical problem in people who do not know whether
they have one is called screening. Currently, there are no commonly
accepted guidelines on who should have endoscopy to check for
Barrett's esophagus. Among the many reasons for the lack of firm
recommendations about screening are the great expense and occasional
risk of side effects of the test. Also, the rate of finding
Barrett's esophagus is low, and finding the problem early has not
been proven to prevent deaths from cancer.
Many physicians recommend that adult patients who are over the
age of 40 and have had GERD symptoms for a number of years have
endoscopy to see whether they have Barrett's esophagus. Screening
for this condition in people who have no symptoms is not
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Barrett's esophagus has no cure, short of surgical removal of the
esophagus, which is a serious operation. Surgery is recommended only
for people who have a high risk of developing cancer or who already
have it. Most physicians recommend treating GERD with acid-blocking
drugs, since this is sometimes associated with improvement in the
extent of the Barrett's tissue. However, this approach has not been
proven to reduce the risk of cancer. Treating reflux with a surgical
procedure for GERD also does not seem to cure Barrett's
Several different experimental approaches are under study. One
attempts to see whether destroying the Barrett's tissue by heat or
other means through an endoscope can eliminate the condition. This
approach, however, has potential risks and unknown
Periodic endoscopic examinations to look for early warning signs
of cancer are generally recommended for people who have Barrett's
esophagus. This approach is called surveillance. When people who
have Barrett's esophagus develop cancer, the process seems to go
through an intermediate stage in which cancer cells appear in the
Barrett's tissue. This condition is called dysplasia and can be seen
only in biopsies with a microscope. The process is patchy and cannot
be seen directly through the endoscope, so multiple biopsies must be
taken. Even then, it can be missed.
The process of change from Barrett's to cancer seems to happen
only in a few patients, less than 1 percent per year, and over a
relatively long period of time. Most physicians recommend that
patients with Barrett's esophagus undergo periodic surveillance
endoscopy to have biopsies. The recommended interval between
endoscopies varies depending on specific circumstances, and the
ideal interval has not been determined.
If a person with Barrett's esophagus is found to have dysplasia
or cancer, the doctor will usually recommend surgery if the person
is strong enough and has a good chance of being cured. The type of
surgery may vary, but it usually involves removing most of the
esophagus and pulling the stomach up into the chest to attach it to
what remains of the esophagus. Many patients with Barrett's
esophagus are elderly and have many other medical problems that make
surgery unwise; in these patients, other approaches to treating
dysplasia are being investigated.
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Many important questions about Barrett's esophagus need further
- find better ways to identify people who have the
- find out what causes it
- test treatments that may prevent or eliminate it
- find better treatments for people who have Barrett's esophagus
The National Institute of Diabetes and Digestive and Kidney
Diseases and the National Cancer Institute sponsor research programs
to investigate Barrett's esophagus.
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- In Barrett's esophagus, the cells lining the esophagus change and become
similar to the cells lining the intestine.
- Barrett's esophagus is associated with gastroesophageal reflux disease
- A small number of people with Barrett's esophagus may develop esophageal
- Barrett's esophagus is diagnosed by upper gastrointestinal endoscopy and
- People who have Barrett's esophagus should have periodic esophageal examinations.
- Taking acid-blocking drugs for GERD may result in improvements in Barrett's
- Removal of the esophagus is recommended only for people who have a high
risk of developing cancer or who already have it.
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For more information about GERD or Barrett's esophagus,
International Foundation for Functional Gastrointestinal
Disorders (IFFGD) Inc.
National Cancer Institute (NCI)
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