Barrett’s Esophagus: An Overview of Causes, Symptoms, and Management Strategies

Barrett’s esophagus, a precancerous condition, is typically acquired and often caused due to chronic gastroesophageal reflux (GERD) (Khieu et al., 2024; Shaheen et al., 2016). GERD is the reflux of gastric contents through the lower esophageal sphincter (LES) into the esophagus – although the stomach lining is resistive to acid needed for digestion, the esophagus is lined by a squamous epithelium which becomes inflamed due to acidic irritants (Khieu et al., 2024). Over time, repeated acidic exposures result in chronic inflammation of the esophagus with columnar metaplastic reaction and development of intestinal-like mucosa characterized by columnar epithelium, often with goblet cells (Inadomi et al., 2018; Khieu et al., 2024).

In addition to GERD, risk factors for Barrett’s esophagus include past or current smoking history, age >50 years, family history of Barrett’s or esophageal adenocarcinoma, genetic mutations, obesity, male genotype, among others (Shaheen et al., 2022). The American College of Gastroenterology (ACG) recommends that individuals with chronic symptoms of GERD who have three additional risk factors undergo screening (American College of Gastroenterology, 2022). Barrett’s esophagus increases the risk for dysplasia and esophageal adenocarcinoma, which is increasing in prevalence (American Association for Cancer Research, 2020; Beydoun et al., 2023; Goldblum, 2003).

Symptoms associated with Barrett esophagus include heartburn, acid regurgitation, dysphagia, hoarseness, chest pain, weight loss, a sore throat, melena, and chronic cough (Khieu et al., 2024). The gold standard tool to diagnose Barrett esophagus is an esophagogastroduodenoscopy with biopsy – and requires a minimum of 1-cm length of salmon-pink columnar metaplasia proximal the esophagogastric junction with confirmation of intestinal metaplasia with goblet cells on biopsy (Khieu et al., 2024). Treatment options are dependent on a variety of factors but can include long-term proton pump inhibitor therapy, repeat endoscopy, endoscopic eradication therapy such as radiofrequency ablation, cryotherapy, hybrid argon plasm coagulation, or endoscopic mucosal resection (Khieu et al., 2024; Rubenstein et al., 2024; Shaheen et al., 2009). Additional interventions include smoking cessation, weight loss, and dietary guidelines that align with recommendations for GERD such as low-fat and high-fiber diets, the avoidance of eating/drinking four hours prior to sleeping, smaller meals throughout the day instead of 2-3 large meals, among others (Jacobson et al., 2006; Khieu et al., 2024; Meining et al., 2000).

Interested in learning more? Check out the articles cited in this post.

Infograph with icons demonstrating symptoms associated with Barrett’s esophagus as well as treatment options.