What is Barrett’s Esophagus?
The esophagus gets a tissue
lining similar to that of the
The muscle becomes rougher
The cells that are normally
found in the intestine replace
the normal esophagus cells
Estimated prevalence of Barrett’s esophagus
6-12% of patients who undergo EGD for GERD.
Short-segment BE: 6-12%
Long-segment BE: 1-5%
1-2% of unselected patients who undergo EGD
Most cases go undetected in the general
population [Autopsy data]. Perhaps 5% of patients
with Barret esophagus are currently being
Symptoms of Barretts esophagus
There are no specific
symptoms, they vary per
Some signs it is likely include:
Constant acid reflux
Burning sensations near chest
Pain in throat and chest when
frequent and longstanding heartburn
trouble swallowing (dysphagia)
vomiting blood (hematemesis)
pain under the breastbone where the esophagus meets
unintentional weight loss because eating is painful
Risk factors for development
of Barrett’s esophagus
Male gender 3 times > female gender
White race >> Blacks & Asians
Abdominal adiposity (obesity)
Genetic factors suspected in some patients/families
Chronic reflux symptoms for > 5-10 years
Age >40-50 years; mean age at diagnosis = 55 yrs
Barrett esophagus occurs due to chronic
inflammation. The principal cause of the chronic
inflammation is gastroesophageal reflux disease,
GERD . In this disease, acidic stomach, bile, small
intestine and pancreatic contents cause damage to the
cells of the lower esophagus
Damage to the squamous
through a metaplastic process
(columnar cells replace squamous cells)
Pathogenesis of Barrett’s Esophagus
with restoration of
short-segment Barrett’s esophagus
Long-segment BE (LSBE): >3-cm segment of distal esophagus (columnar
mucosa with intestinal metaplasia)
Short-segment BE (SSBE): <3-cm segment (usually tongues or islands of
columnar mucosa with intestinal metaplasia)
Patients with LSBE tend to have greater esophageal acid exposure than
SSBE, as well as lower LES pressures and more esophageal dysmotility.
LSBE (classic BE) is much better studied.
We are currently managing LSBE and SSBE similarly.
However, questions remain:
Does SSBE have the same pathogenesis?
Does SSBE have a lower risk of cancer?
Does SSBE progress to LSBE?
Does the length of BE correlate with cancer risk?
Long segement type
Short segement type
Physiology of Barrett’s
When food becomes backed
up, the juices of the stomach
go back up the esophagus.
This is also known as severe
When having a repeated
injury to the Esophagus
, acidic fluid changes the
types of cells lining it from
squamous to columnar
Fluid may contain bile acids.
Development of Neoplasia in Barrett’s
2Gastric acid reflux
1Duodenal bile reflux
secondary bile salts
salt induced chronic
Neoplasia in Barrett’s
Development of esophageal adenocarcinoma from
Compelling evidence exists for a dysplasia-carcinoma
sequence in BE.
Specialized columnar epithelium progresses in some patients
→ low-grade dysplasia → high-grade dysplasia →
Not every patient with low-grade dysplasia progresses, and
low-grade dysplasia can even spontaneously revert back to
Time course for development of cancer highly variable.
Most patients never progress to dysplasia. Less than 5% of
Barrett’s patients will develop cancer.
Why do we care about Barrett’s esophagus?
Patients with BE have an increased risk of developing esophageal
Over the past 30 years, the incidence of squamous cell cancer of the
esophagus has stayed constant, while the incidence of adenocarcinoma
has increased 6-fold! This is an increase that exceeds that of any other
Today, adenocarcinoma accounts for more than half of esophageal
Patients with BE have about a 30-40 fold increased risk of
adenocarcinoma of esophagus.
Risk of a BE patient developing cancer is estimated to be about 1 per
200 patient-years follow-up.
Despite all this, most patients with BE do not develop esophageal
cancer. [Less than 5%]
GERD is a precursor to the
diagnosis of Barrett’s
The tissue lining of the
esophagus has changed.
Endoscopy (a long thin tube
that examines the lining of
the esophagus and stomach)
confirms whether or not cells
1. Locate gastro-
3. Describe extent of
2. Recognize the
Three Essential Steps for
Endoscopic Diagnosis and
Therapy of Barrett’s Esophagus
TREATMENT OF the mai cause that is GERD-
Treatment should improve acid reflux symptoms, and
may keep Barrett's esophagus from getting worse.
Treatment may involve lifestyle changes and
medications such as:
Antacids after meals and at bedtime
Histamine H2 receptor blockers(viz rantidine
Proton pump inhibitors(pantoprazole,lansoprazole
N.B.- Lifestyle changes, medications, and anti-
surgery may help with symptoms of GERD, but will
make Barrett's esophagus go away.
TREATMENT OF BARRETT'S ESOPHAGUS
Surgery or other procedures may be recommended if a
biopsy shows cell changes that are very likely to lead to
cancer. Such changes are called severe or high-grade
Removal of intestinal
cells from esophagus and
Removal of the
Recent advance in surgical
Photodynamic therapy (PDT) uses a special laser
device, called an esophageal balloon, along with a drug
Other procedures use different types of high energy to
destroy the precancerous tissue.
Surgery removes the abnormal lining.
Fun and Interesting Facts
Only about 1% of all Americans suffer from Barret’s
10% to 15% of people with chronic GERD get Barrett’s
About 3.3 million adults over 50 years of age in the United
States have Barrett’s Esophagus.
Men are more likely to develop Barrett’s Esophagus than
women and the ratio is 2:1, and EUROPEAN males are
more likely to have it than any other race.