Reviewed by: Stephanie Doggett, PA-C
Written by: Lauryn Feil
Barrett’s esophagus is a condition that can occur in patients with gastroesophageal reflux disease or GERD. It affects 1-2% of the adult population in the United States. The cells of the esophagus are not designed to be exposed to chronic acid and other stomach contents that frequently happens with GERD. When Barrett’s esophagus occurs, the inner lining of the esophagus has changed to a stomach or intestinal cell that is better equipped to handle the acidic environment. Barrett’s esophagus is considered a pre-malignant condition that predisposes patients to esophageal adenocarcinoma. Although the risk is low, it is similar to a polyp found in the colon. Patients with Barrett’s esophagus should have a surveillance endoscopy every three to five years as a precautionary measure.
Who should be screened for Barrett’s esophagus?
Any person that has a long history of acid reflux symptoms should be screened! Unfortunately, there is no consensus guidelines on when people should undergo a screening endoscopy like there is with colonoscopies. Once a patient is identified as having Barrett’s esophagus they are then placed in a surveillance program.
How does UT Health Austin test for Barrett’s esophagus?
The Heartburn and Esophageal Disorders Center, a clinical practice within Digestive Health, the clinical partnership between UT Health Austin and Ascension Seton, utilizes several different technologies to test for Barrett’s esophagus. Typical testing occurs at the time of an endoscopy where the endoscopist will examine the lining of the esophagus and take biopsies of any areas of concern. UT Health Austin surgeons in the Heartburn and Esophageal Disorders Clinic also use a technology called optical endomicroscopy. This is like a small microscope that can look at the esophageal lining at a cellular level, essentially allowing for real time pathology. This allows for fast diagnosis of Barrett’s esophagus. Additionally, brush biopsies are used that allow for a wider and deeper area of tissue sample. This allows for more accurate and increased cellular change detection. By utilizing these advanced technologies, there is an increased chance of detecting Barrett’s esophagus two to four times that of normal tissue biopsies alone. UT Health Austin is the only group that utilizes this unique combination of advanced technologies in Central Texas.
What is dysplasia?
The present understanding is that Barrett’s esophagus has several steps before it develops into esophageal adenocarcinoma, these changes are called dysplasia. With regular Barrett’s esophagus without dysplasia, the cells are still normal looking intestinal cells that have a normal architecture. With dysplasia, the Barrett’s esophagus cells start to appear abnormal and no longer look similar to one another. These changes can be classified as low-grade up to high-grade, each increasing the risk of developing esophageal adenocarcinoma.
How is Barrett’s esophagus treated?
Barrett’s esophagus without dysplasia is usually monitored with an upper endoscopy and biopsies every three to five years to ensure there is no progression to dysplasia or even cancer. Typically no treatment is necessary for Barrett’s esophagus, other than controlling acid exposure to the esophagus, which can be done by medication or potentially with anti-reflux surgery. Once dysplasia occurs, this is typically treated with radiofrequency ablation (RFA). RFA is minimally invasive and works by using heat to ablate the lining of the esophagus to eradicate the abnormal cells. This treatment significantly decreases the risk of progression to cancer.
If someone has Barrett’s esophagus, how often should they have an endoscopy (or other screening) to check for dysplasia?
Typically, these patients undergo surveillance endoscopy every three years. In our patient population that has undergone anti-reflux surgery, we like to repeat an endoscopy at the one year postoperative mark.
Screenings for Barrett’s Esophagus
- Endoscopy: a nonsurgical procedure used to examine an individuals’ digestive tract. Doctors can view pictures of the patient’s digestive tract using an endoscope - a flexible tube with an attached light and camera.
- Optical Endomicroscopy: enhanced imaging technology that provides real-time diagnosis of intestinal metaplasia (IM) and dysplasia, reducing the need for tissue biopsy.
- Brush biopsies: soft-bristled brushes are run over a wider area of the esophageal mucus membrane increasing the amount of cells collected for biopsy.