Barrett esophagus - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Barrett esophagus is a change in the normal squamous epithelium of the esophagus to specialized intestinal metaplasia.
Presentation may be asymptomatic, but it typically occurs in middle-aged white men who have had chronic gastroesophageal reflux disease (GERD). Additional risk factors include tobacco use and obesity.
Cancer risk is determined by the degree of dysplasia.
Endoscopic screening and surveillance programs have multiple shortcomings. Screening of the general population is not recommended, and surveillance intervals vary depending on histologic findings.
Proton-pump inhibitors are commonly used to control GERD symptoms and may reduce the risk of neoplastic Barrett esophagus.

Barrett esophagus; note salmon-colored mucosa extending superior to the gastroesophageal junction with marked irregular border

From the personal collection of Dr Vic Velanovich; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Barrett esophagus; note salmon-colored mucosa extending superior to the gastroesophageal junction as a continuous column
Barrett esophagus; note salmon-colored mucosa extending superior to the gastroesophageal junction with marked irregular border
Barrett metaplasia without dysplasia, demonstrating columnar epithelium with goblet cells from superior to the gastroesophageal junction
Barrett metaplasia with low-grade dysplasia; note the more irregular cells and nuclei
Barrett metaplasia with high-grade dysplasia; note more advanced irregularity of the cells
Barrett metaplasia with high-grade dysplasia associated with a focus of intramucosal carcinoma; note the frankly malignant cells beyond the confines of the basement membrane to involve the lamina propria

Citations

Key Articles

Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014 Jan;63(1):7-42.[Abstract][Full Text]
Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-87.[Abstract][Full Text]
Fitzgerald RC. Molecular basis of Barrett's oesophagus and oesophageal adenocarcinoma. Gut. 2006 Dec;55(12):1810-20.[Abstract]
Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017 Feb;49(2):191-8.[Abstract][Full Text]
Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology. 2006 Nov;131(5):1392-9.[Abstract][Full Text]

Referenced Articles

1. Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut. 2014 Jan;63(1):7-42.[Abstract][Full Text]
2. Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006 Jul;22(4):406-11.[Abstract]
3. Shaheen NJ. Advances in Barrett's esophagus and esophageal adenocarcinoma. Gastroenterology. 2005 May;128(6):1554-66.[Abstract]
4. Flejou JF, Svrcek M. Barrett's oesophagus: a pathologist's view. Histopathology. 2007 Jan;50(1):3-14.[Abstract]
5. Peters JH. The importance of symptom assessment in the surgical treatment of gastroesophageal reflux disease and Barrett's esophagus. Surg Endosc. 2006 Apr;20(suppl 2):S456-61.[Abstract]
6. Sharma P. Barrett esophagus: a review. JAMA. 2022 Aug 16;328(7):663-71.[Abstract]
7. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-87.[Abstract][Full Text]
8. Fabian T, Leung A. Epidemiology of Barrett's esophagus and esophageal carcinoma. Surg Clin North Am. 2021 Jun;101(3):381-9.[Abstract]
9. Saha B, Vantanasiri K, Mohan BP, et al. Prevalence of Barrett's esophagus and esophageal adenocarcinoma with and without gastroesophageal reflux: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024 Jul;22(7):1381-94.e7.[Abstract][Full Text]
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11. Thrift AP. Global burden and epidemiology of Barrett oesophagus and oesophageal cancer. Nat Rev Gastroenterol Hepatol. 2021 Jun;18(6):432-43.[Abstract]
12. Fein M, Maroske J, Fuchs KH. Importance of duodenogastric reflux in gastro-oesophageal reflux disease. Br J Surg. 2006 Dec;93(12):1475-82.[Abstract]
13. Oh DS, Hagen JA, Fein M, et al. The impact of reflux composition on mucosal injury and esophageal function. J Gastrointest Surg. 2006 Jun;10(6):787-96.[Abstract]
14. Shalauta MD, Saad R. Barrett's esophagus. Am Fam Physician. 2004 May 1;69(9):2113-8.[Abstract]
15. Odze RD. Update on the diagnosis and treatment of Barrett esophagus and related neoplastic precursor lesions. Arch Pathol Lab Med. 2008 Oct;132(10):1577-85.[Abstract][Full Text]
16. Peters CJ, Fitzgerald RC. Systematic review: the application of molecular pathogenesis to prevention and treatment of oesophageal adenocarcinoma. Aliment Pharmacol Ther. 2007 Jun 1;25(11):1253-69.[Abstract][Full Text]
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19. Fitzgerald RC. Molecular basis of Barrett's oesophagus and oesophageal adenocarcinoma. Gut. 2006 Dec;55(12):1810-20.[Abstract]
20. Vallböhmer D, DeMeester SR, Oh DS, et al. Antireflux surgery normalizes cyclooxygenase-2 expression in squamous epithelium of the distal esophagus. Am J Gastroenterol. 2006 Jul;101(7):1458-66.[Abstract]
21. Colleypriest BJ, Farrant JM, Slack JM, et al. The role of Cdx2 in Barrett's metaplasia. Biochem Soc Trans. 2010 Apr;38(2):364-9.[Abstract]
22. Sikkema M, de Jonge PJ, Steyerberg EW, et al. Risk of esophageal adenocarcinoma and mortality in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2010 Mar;8(3):235-44; quiz e32.[Abstract][Full Text]
23. Winberg H, Lindblad M, Lagergren J, et al. Risk factors and chemoprevention in Barrett's esophagus - an update. Scand J Gastroenterol. 2012 Apr;47(4):397-406.[Abstract]
24. Taylor JB, Rubenstein JH. Meta-analyses of the effect of symptoms of gastroesophageal reflux on the risk of Barrett's esophagus. Am J Gastroenterol. 2010 Aug;105(8):1729-37.[Abstract][Full Text]
25. Guardino JM, Khandwala F, Lopez R, et al. Barrett's esophagus at a tertiary care center: association of age on incidence and prevalence of dysplasia and adenocarcinoma. Am J Gastroenterol. 2006 Oct;101(10):2187-93.[Abstract]
26. Cook MB, Wild CP, Forman D. A systematic review and meta-analysis of the sex ratio for Barrett's esophagus, erosive reflux disease, and nonerosive reflux disease. Am J Epidemiol. 2005 Dec 1;162(11):1050-61.[Abstract]
27. Chak A, Ochs-Balcom H, Falk G, et al. Familiality in Barrett's esophagus, adenocarcinoma of the esophagus, and adenocarcinoma of the gastroesophageal junction. Cancer Epidemiol Biomarkers Prev. 2006 Sep;15(9):1668-73.[Abstract][Full Text]
28. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005 Aug 2;143(3):199-211.[Abstract]
29. Veugelers PJ, Porter GA, Guernsey DL, et al. Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett's esophagus and esophageal adenocarcinoma. Dis Esophagus. 2006;19(5):321-8.[Abstract]
30. De Jonge PJ, Steyerberg EW, Kuipers EJ, et al. Risk factors for the development of esophageal adenocarcinoma in Barrett's esophagus. Am J Gastroenterol. 2006 Jul;101(7):1421-9.[Abstract]
31. Omer ZB, Ananthakrishnan AN, Nattinger KJ, et al. Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis. Clin Gastroenterol Hepatol. 2012 Jul;10(7):722-7.[Abstract][Full Text]
32. Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement. Endoscopy. 2017 Feb;49(2):191-8.[Abstract][Full Text]
33. National Institute for Health and Care Excellence. Barrett's oesophagus and stage 1 oesophageal adenocarcinoma: monitoring and management. Feb 2023 [internet publication].[Full Text]
34. Andrici J, Tio M, Cox MR, et al. Hiatal hernia and the risk of Barrett's esophagus. J Gastroenterol Hepatol. 2013 Mar;28(3):415-31.[Abstract]
35. Shariff MK, Bird-Lieberman EL, O'Donovan M, et al. Randomized crossover study comparing efficacy of transnasal endoscopy with that of standard endoscopy to detect Barrett's esophagus. Gastrointest Endosc. 2012 May;75(5):954-61.[Abstract]
36. Bhardwaj A, Hollenbeak CS, Pooran N, et al. A meta-analysis of the diagnostic accuracy of esophageal capsule endoscopy for Barrett's esophagus in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2009 Jun;104(6):1533-9.[Abstract]
37. Mannath J, Subramanian V, Hawkey CJ, et al. Narrow band imaging for characterization of high grade dysplasia and specialized intestinal metaplasia in Barrett's esophagus: a meta-analysis. Endoscopy. 2010 May;42(5):351-9.[Abstract]
38. Ngamruengphong S, Sharma VK, Das A. Diagnostic yield of methylene blue chromoendoscopy for detecting specialized intestinal metaplasia and dysplasia in Barrett's esophagus: a meta-analysis. Gastrointest Endosc. 2009 May;69(6):1021-8.[Abstract]
39. Qumseya BJ, Wang H, Badie N, et al. Advanced imaging technologies increase detection of dysplasia and neoplasia in patients with Barrett's esophagus: a meta-analysis and systematic review. Clin Gastroenterol Hepatol. 2013 Dec;11(12):1562-70.e1-2.[Abstract][Full Text]
40. Wu J, Pan YM, Wang TT, et al. Confocal laser endomicroscopy for detection of neoplasia in Barrett's esophagus: a meta-analysis. Dis Esophagus. 2014 Apr;27(3):248-54.[Abstract][Full Text]
41. Waxman I, Konda VJ. Endoscopic techniques for recognizing neoplasia in Barrett's esophagus: which should the clinician use? Curr Opin Gastroenterol. 2010 Jul;26(4):352-60.[Abstract]
42. Nurgalieva Z, Lowrey A, El-Serag HB. The use of cytokeratin stain to distinguish Barrett's esophagus from contiguous tissues: a systematic review. Dig Dis Sci. 2007 May;52(5):1345-54.[Abstract]
43. Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop. Gastroenterology. 2004;127:310-30.[Abstract][Full Text]
44. Dickman R, Kim JL, Camargo L, et al. Correlation of gastroesophageal reflux disease symptom characteristics with long-segment Barrett's esophagus. Dis Esophagus. 2006;19(5):360-5.[Abstract]
45. Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology. 2006 Nov;131(5):1392-9.[Abstract][Full Text]
46. Bhat SK, McManus DT, Coleman HG, et al. Oesophageal adenocarcinoma and prior diagnosis of Barrett's oesophagus: a population-based study. Gut. 2015 Jan;64(1):20-5.[Abstract]
47. Sharma P, Hawes RH, Bansal A, et al. Standard endoscopy with random biopsies versus narrow band imaging targeted biopsies in Barrett's oesophagus: a prospective, international, randomised controlled trial. Gut. 2013 Jan;62(1):15-21.[Abstract]
48. ASGE Standards of Practice Committee. American Society for Gastrointestinal Endoscopy guideline on informed consent for GI endoscopic procedures. Gastrointest Endosc. 2022 Feb;95(2):207-15.e2.[Abstract][Full Text]
49. ASGE Standards of Practice Committee, Coelho-Prabhu N, Forbes N, et al. Adverse events associated with EGD and EGD-related techniques. Gastrointest Endosc. 2022 Sep;96(3):389-401.e1.[Abstract][Full Text]
50. di Pietro M, Fitzgerald RC; BSG Barrett's guidelines working group. Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett's oesophagus with low-grade dysplasia. Gut. 2018 Feb;67(2):392-3.[Abstract][Full Text]
51. Moyo K, Khong TK. High-dose PPI and aspirin as chemoprevention in Barrett's oesophagus. Drug Ther Bull. 2020 Mar;58(3):39-40.[Abstract]
52. Rubenstein JH, Sawas T, Wani S, et al. AGA clinical practice guideline on endoscopic eradication therapy of Barrett's esophagus and related neoplasia. Gastroenterology. 2024 Jun;166(6):1020-55.[Abstract][Full Text]
53. Wani S, Qumseya B, et al. Standards of Practice Committee. Endoscopic eradication therapy for patients with Barrett's esophagus-associated dysplasia and intramucosal cancer. Gastrointest Endosc. 2018 Apr;87(4):907-31.e9.[Abstract][Full Text]
54. Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014 Mar 26;311(12):1209-17.[Abstract][Full Text]
55. Qumseya BJ, Wani S, Desai M, et al. Adverse events after radiofrequency ablation in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1086-95.e6.[Abstract][Full Text]
56. Tseng EE, Wu TT, Yeo CJ, et al. Barrett's esophagus with high grade dysplasia: surgical results and long-term outcome - an update. J Gastrointest Surg. 2003 Feb;7(2):164-70.[Abstract]
57. Ell C, May A, Gossner L, et al. Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterology. 2000 Apr;118(4):670-7.[Abstract]
58. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009 May 28;360(22):2277-88.[Abstract][Full Text]
59. Rice TW, Sontag SJ. Debate: esophagectomy is the treatment of choice for high grade dysplasia in Barrett's esophagus. Am J Gastroenterol. 2006 Oct;101(10):2177-9.[Abstract]
60. Gilbert S, Jobe BA. Surgical therapy for Barrett's esophagus with high-grade dysplasia and early esophageal carcinoma. Surg Oncol Clin N Am. 2009 Jul;18(3):523-31.[Abstract]
61. Agarwal S, Alshelleh M, Scott J, et al. Comparative outcomes of radiofrequency ablation and cryoballoon ablation in dysplastic Barrett's esophagus: a propensity score-matched cohort study. Gastrointest Endosc. 2022 Mar;95(3):422-31.e2.[Abstract]
62. ClinicalTrials.gov. Evaluation of effect of CryoBalloon focal ablation system on human esophageal epithelium (ColdPlay2). ClinicalTrials.gov identifier: NCT02534233. May 2022 [internet publication].[Full Text]
63. ClinicalTrials.gov. Multi-center clinical study to evaluate the C2 CryoBalloon focal ablation system (ColdPlayIII). ClinicalTrials.gov identifier: NCT02514525. Apr 2022 [internet publication].[Full Text]
64. Dulai GS, Jensen DM, Cortina G, et al. Randomized trial of argon plasma coagulation versus multipolar electrocoagulation for ablation of Barrett's esophagus. Gastrointest Endosc. 2005 Feb;61(2):232-40.[Abstract]
65. Kastelein F, Spaander MC, Biermann K, et al. Nonsteroidal anti-inflammatory drugs and statins have chemopreventative effects in patients with Barrett's esophagus. Gastroenterology. 2011 Dec;141(6):2000-8.[Abstract][Full Text]
66. Crockett SD, Lippmann QK, Dellon ES, et al. Health-related quality of life in patients with Barrett's esophagus: a systematic review. Clin Gastroenterol Hepatol. 2009 Jun;7(6):613-23.[Abstract][Full Text]