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At a glance
- Barrett’s esophagus is diagnosed with an endoscopy and confirmed with biopsies.
- Most people with Barrett’s esophagus never develop esophageal cancer.
- Regular surveillance endoscopy looks for dysplasia — precancerous change — so it can be treated early.
- Dysplasia can often be treated endoscopically, for example with radiofrequency ablation.
What happens in Barrett’s esophagus
The esophagus is normally lined with flat cells similar to skin. With repeated reflux, the lining near the stomach can be replaced with a different type of cell that looks more like the lining of the intestine. This is thought to be a protective adaptation, but it carries a small risk of progressing through precancerous stages (dysplasia) to esophageal adenocarcinoma.
According to NIDDK, an estimated 5% to 15% of people with GERD develop Barrett’s esophagus. It often causes no symptoms of its own; symptoms usually come from the underlying reflux.
Keeping cancer risk in perspective
Barrett’s esophagus is the only known precursor to esophageal adenocarcinoma, which is why it’s taken seriously. At the same time, large population studies have found the yearly risk of cancer in people with Barrett’s without dysplasia to be low, and most people with Barrett’s never develop cancer. Risk is higher when dysplasia is present, particularly high-grade dysplasia.
How Barrett’s esophagus is found
Diagnosis requires an upper endoscopy showing the characteristic lining, confirmed by biopsies. Guidelines suggest that some people with long-standing reflux who have additional risk factors — such as being male, being over 50, smoking, carrying excess weight around the abdomen, or having a family history of Barrett’s esophagus or esophageal cancer — may benefit from a screening endoscopy. The 2022 ACG guideline also broadened the accepted screening methods to include some non-endoscopic tests.
Surveillance
Surveillance means periodic endoscopy with biopsies to look for dysplasia. How often depends on the length of the Barrett’s segment, whether dysplasia has been found, and whether treatment has been done. The 2022 ACG guideline lengthened the recommended interval for people with short segments of Barrett’s without dysplasia.
Treatment
- Acid control. Most people with Barrett’s esophagus take a PPI to control reflux and heal inflammation.
- Endoscopic eradication therapy. When dysplasia is found, the 2022 ACG guideline recommends treating it endoscopically. Options include removing raised areas (endoscopic mucosal resection) and destroying the remaining abnormal lining with radiofrequency ablation (sometimes known by the brand name BARRX) or cryotherapy. Surveillance continues afterward.
- Anti-reflux surgery. A fundoplication or other anti-reflux procedure controls reflux of all kinds, not just acid. Several studies have found that Barrett’s esophagus regresses after surgery in a meaningful share of patients — most often shorter segments and low-grade dysplasia — and some suggest regression is more likely after surgery than with medication alone. Surveillance continues afterward.
Radiofrequency ablation (BARRX) for Barrett’s esophagus is one of Dr. Speer’s areas of specialized expertise. Learn more in her professional profile.
Common questions
Does Barrett’s esophagus mean I’ll get cancer?
No. Barrett’s esophagus increases the risk of one type of esophageal cancer, but most people with Barrett’s never develop cancer, and surveillance is designed to catch precancerous change early.
For people with Barrett’s esophagus without dysplasia, the yearly chance of developing cancer is low. The risk rises if dysplasia — precancerous change — develops, which is exactly what surveillance biopsies look for. When dysplasia is found, it can usually be treated through an endoscope before cancer develops. Keeping reflux well controlled, not smoking, and maintaining a healthy weight are sensible steps for anyone with Barrett’s esophagus.
How often do I need an endoscopy if I have Barrett’s esophagus?
It depends on the length of the Barrett’s segment and whether dysplasia has been found; people without dysplasia typically have surveillance every few years, and those with dysplasia or after treatment are checked more often.
The 2022 American College of Gastroenterology guideline sets intervals based on these factors and lengthened the interval for short segments without dysplasia. After endoscopic treatment, surveillance follows a separate schedule based on the most advanced change found before treatment. Your gastroenterologist or endoscopist will recommend a specific schedule for you.
Can reflux surgery reverse Barrett’s esophagus?
It may. Several studies have found that Barrett’s esophagus regresses after anti-reflux surgery in a meaningful share of patients — becoming shorter, losing low-grade dysplasia, or no longer showing up on biopsies — and some suggest regression is more likely after surgery than with medication alone. Results vary, so surveillance continues afterward.
Medication reduces stomach acid, but it doesn’t stop stomach contents — including bile and other non-acid fluid — from washing back into the esophagus. A well-functioning fundoplication restores the barrier and stops reflux of all kinds, which is thought to be why the lining sometimes heals back toward normal after surgery.
What studies have found:
- Regression after anti-reflux surgery has been reported most often in shorter segments of Barrett’s esophagus and in low-grade dysplasia. Long segments regress less often.
- In a prospective study of patients with low-grade dysplasia, dysplasia regressed more often after Nissen fundoplication than with medical therapy.
- Surgical series from several centers have documented regression — sometimes complete — in a substantial number of patients followed after surgery.
What isn’t settled yet: most of this evidence comes from surgical series and smaller studies rather than large randomized trials, and studies haven’t yet shown that surgery lowers cancer risk compared with well-managed medication. For that reason, surveillance endoscopy continues after surgery, and dysplasia, when found, is treated with endoscopic therapies such as radiofrequency ablation.
Anti-reflux surgery is worth discussing if you have Barrett’s esophagus along with ongoing reflux symptoms, regurgitation, a hiatal hernia, or the prospect of taking medication for life.
Sources
- Shaheen NJ, et al. Diagnosis and Management of Barrett’s Esophagus — an updated ACG guideline. Am J Gastroenterol. 2022;117(4):559–587.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Barrett’s Esophagus.
- Hvid-Jensen F, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375–1383.
- Gurski RR, Peters JH, Hagen JA, et al. Barrett’s esophagus can and does regress after antireflux surgery — a study of prevalence and predictive features. J Am Coll Surg. 2003;196(5):706–712.
- Oelschlager BK, Barreca M, Chang L, et al. Clinical and pathologic response of Barrett’s esophagus to laparoscopic antireflux surgery. Ann Surg. 2003;238(4):458–466.
- Rossi M, Barreca M, de Bortoli N, et al. Efficacy of Nissen fundoplication versus medical therapy in the regression of low-grade dysplasia in patients with Barrett esophagus — a prospective study. Ann Surg. 2006;243(1):58–63.
This page is general education. It can’t account for your history, test results, or other conditions, so please discuss your situation with your own clinician.