Brief Overview: Barrett’s Esophagus is a condition in which the normal lining of the esophagus is replaced with tissue similar to the lining of the intestines. It is a complication of chronic gastroesophageal reflux disease (GERD) and increases the risk of developing esophageal adenocarcinoma, a rare but serious cancer.
Prevalence: The prevalence of Barrett’s esophagus in the US is estimated to be ~5.6% of adults, according to UpToDate.
Etiology: According to UpToDate, “Barrett's esophagus results from chronic reflux esophagitis caused by the gastroesophageal reflux of acid and other noxious substances.”
Risk Factors:
- Male
- Age (average age of dx is 55yo)
- GERD
- Obesity
- Family history
- Smoking
- White ethnicity
Commonly Associated Conditions:
- GERD
- Hiatal hernia
- Esophagitis
Common Medications:
- PPI – omeprazole, pantoprazole
Common Labs, Imaging, and Tests:
- Upper endoscopy with biopsy
Common Symptoms:
- Asymptomatic
- May have symptoms of underlying GERD: heartburn, regurgitation
Common Treatments:
- Medication (see above)
- Diet changes: avoid acidic foods (citrus, tomatoes), chocolate, coffee, caffeine, peppermint, alcohol, fatty foods
- Behavior modification: avoid eating meals right before lying down or bedtime, eat smaller more frequent meals, elevate head of bed
Physical Findings:
- Typically, normal physical exam
- This is found on imaging studies
Potential Complications and Contraindications:
- Esophageal adenocarcinoma
- Progression from low-grade to high-grade dysplasia
- Long-term PPI use may require additional monitoring
General Health and Lifestyle Guidance:
- Smoking cessation
- Make sure to work with your healthcare provider to manage underlying GERD
- Avoid any GERD-triggering foods or substances
- Limit alcohol intake
- Weight loss recommendations may be indicated
Suggested Questions to Ask Patients:
- How long have you experienced reflux or heartburn symptoms?
- Are you consistently taking your PPI or acid reducers?
- Have you had previous endoscopy or biopsy results discussed with you?
- Do you have trouble swallowing or unintentional weight loss?
- Are you aware of your surveillance schedule or next check-up?
Suggested Talking Points:
- You may need periodic monitoring for precancerous changes
- Make sure to report any new, worsening, or persistent symptoms to your healthcare provider
Sources:
- UpToDate
- https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/eating-diet-nutrition