Barrett’s esophagus is a change in the lining of the esophagus related to reflux of stomach contents into the esophagus. For a small minority, the disorder can progress to a type of cancer called esophageal adenocarcinoma. Read more about esophageal cancer. University of Michigan’s dedicated multidisciplinary team is made up of specialists in gastroenterology, minimally invasive surgery, thoracic surgery, radiology, and pathology with expertise in diagnosing and treating Barrett’s esophagus.
U-M patients benefit from ongoing research happening at U-M that has advanced the ability to predict an individual’s risk for esophageal cancer. We are also offering patients cutting-edge therapies that are not yet widely available. Out of this research has come a personalized tool called M-BERET that is used to predict an individual’s probability of having Barrett’s esophagus, which you may want to learn more about so that you may discuss your risk with your physician.
Barrett’s Esophagus Symptoms and Risk Factors
While the disorder itself does not cause symptoms, patients with symptoms of gastroesophageal reflux disease, or GERD—a digestive problem where there is too much backflow of the stomach’s contents into the esophagus—are more likely to have Barrett’s esophagus than those without GERD symptoms.
Typical GERD symptoms include:
- Heartburn (burning behind the breastbone traveling toward the neck)
- Regurgitation (effortless movement of stomach contents into the chest)
Other important risk factors for Barrett’s esophagus and esophageal adenocarcinoma include:
- Caucasian race
- Older age
- Tobacco use
Risk factors for the other major type of esophageal cancer—squamous cell carcinoma—include:
- African-American race
- Older age
- Tobacco use
- Alcohol use
Researchers at the University of Michigan have developed a personalized tool for predicting an individual’s probability of having Barrett’s esophagus, http://mberet.umms.med.umich.edu/, which should be discussed with your physician.
Diagnosing Barrett’s Esophagus
To diagnose Barrett’s esophagus, we begin by conducting a comprehensive exam and collecting a thorough history. Based on your risk factors, your doctor might recommend an upper endoscopy. Upper endoscopy, also known as an esophagogastroduodenoscopy or EGD, uses an endoscope—a lighted, flexible tube, about the thickness of a finger—to examine the upper gastrointestinal tract, consisting of the esophagus, stomach, and duodenum, which is the first part of the small intestine. A special instrument may be passed through the tube to take a small piece of tissue (a biopsy) for examination in the laboratory. Studies have shown that on average, surveillance endoscopies performed by most gastroenterologists do not obtain enough biopsies to identify abnormal development, also known as dysplasia, which is a step towards cancer. Our doctors have great expertise in recognizing subtle changes that indicate dysplasia. We also have world-renowned experts in Barrett’s esophagus reviewing the biopsies under the microscope.
Treatment for Barrett’s Esophagus and Esophageal Cancer
There are a variety of treatments for Barrett’s esophagus depending on whether or not dysplasia has been found in the esophagus.
For no dysplasia:
- Lifestyle changes: Recommendations may include dieting, exercising to maintain a healthy weight, and avoiding tobacco.
- Endoscopic surveillance for dysplasia: We will perform an outpatient upper endoscopy with biopsy, typically every 3 to 5 years, to look for evidence of cancer.
For low-grade dysplasia:
- Lifestyle changes: maximizing acid-reducing medications, and endoscopic surveillance.
- Occasionally: endoscopy therapies (listed below)
For high-grade dysplasia (these procedures are not widely available):
- Endoscopic mucosal resection of dysplasia: An outpatient procedure where large areas of the lining of the esophagus are removed through an endoscope, preventing progression to cancer in most cases and allowing the normal lining of the esophagus to return. For early cancers, this is also used for determining how deeply the cancer invades into the wall of the esophagus and may be as effective as surgery for curing very early cancers.
- Radiofrequency ablation: An outpatient procedure where the lining of the esophagus is burnt off, allowing the normal lining to return.
- Esophagectomy: This surgical procedure allows the stomach to function as a replacement for the esophagus by removing the esophagus, pulling the stomach up into the chest, and attaching it to the remaining portion of the esophagus.
- Cryospray: uses very cold liquid to freeze off the lining of the esophagus, allowing the normal lining to return.
Research for Barrett’s Esophagus and Esophageal Cancer
We have a robust clinical research program at the University of Michigan, with our experts involved in studies assessing the outcomes and relative effectiveness of endoscopic therapies for Barrett’s esophagus, as well as developing sophisticated endoscopic imaging techniques for identifying patients with Barrett’s esophagus who are most at risk for developing cancer. Patients who qualify can participate in clinical trials, allowing them access to the latest therapies available.