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Barrett's Esophagus: Symptoms, Causes, and Treatments

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How Is Barrett's Esophagus Diagnosed? continued...

To perform an endoscopy, a doctor called a gastroenterologist inserts a long flexible tube with a camera attached down the throat into the esophagus after giving the patient a sedative. The process may feel a little uncomfortable, but it isn't painful. Most people have little or no problem with it.

Once the tube is inserted, the doctor can visually inspect the lining of the esophagus. Barrett's esophagus, if it's there, is visible on camera, but the diagnosis requires a biopsy. The doctor will remove a small sample of tissue to be examined under a microscope in the laboratory to confirm a diagnosis.

The sample will also be examined for the presence of precancerous cells or cancer. If the biopsy confirms the presence of Barrett's esophagus, your doctor will probably recommend a follow-up endoscopy and biopsy to examine more tissue for early signs of developing cancer.

If you have Barrett's esophagus but no cancer or precancerous cells are found, the doctor will still most likely recommend that you have periodic repeat endoscopy. This is a precaution, because cancer can develop in Barrett tissue years after diagnosing Barrett's esophagus. If precancerous cells are present in the biopsy, your doctor will discuss treatment and surveillance options with you.

Can Barrett's Esophagus Be Treated?

One of the primary goals of treatment is to prevent or slow the development of Barrett's esophagus by treating and controlling acid reflux. This is done with lifestyle changes and medication. Lifestyle changes include taking steps such as:

  • Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can aggravate reflux.
  • Avoid alcohol, caffeinated drinks, and tobacco.
  • Lose weight. Being overweight increases your risk for reflux.
  • Sleep with the head of the bed elevated. Sleeping with your head raised may help prevent the acid in your stomach from flowing up into the esophagus.
  • Don't lie down for 3 hours after eating.
  • Take all medicines with plenty of water.

The doctor may also prescribe medications to help. Those medications may include:

  • Proton pump inhibitors that reduce the production of stomach acid
  • Antacids to neutralize stomach acid
  • H2 blockers that lessen the release of stomach acid
  • Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines

Are There Treatments That Specifically Target Barrett's Esophagus?

There are several treatments, including surgery, that are designed specifically to focus on the abnormal tissue. They include:

  • Photodynamic therapy (PDT) uses a laser that's inserted into the esophagus with the endoscope to kill abnormal cells in the lining without damaging normal tissue. Before the procedure, the patient takes a drug known as Photofrin, which causes cells to become light-sensitive.
  • Endoscopic mucosal resection (EMR) lifts the abnormal lining and cuts it off the wall of the esophagus before it's removed through the endoscope. The goal is to remove any precancerous or cancer cells contained in the lining. If cancer cells are present, an ultrasound is done first to be sure the cancer hasn't moved deeper into the esophagus walls.
  • Surgery to remove most of the esophagus is an option in cases where severe precancer (dysplasia) or cancer has been diagnosed. The earlier the surgery is done following the diagnosis, the better the chance for the cure.
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