Barrett’s 

Esophagus 

National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is Barrett’s esophagus? 

Barrett’s esophagus is a condition in which 

the tissue lining the esophagus—the muscular tube that connects the mouth to the 

stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia. 

No signs or symptoms are associated with 

Barrett’s esophagus, but it is commonly 

found in people with gastroesophageal 

reflux disease (GERD). A small number of 

people with Barrett’s esophagus develop a 

rare but often deadly type of cancer of the 

esophagus. 

Barrett’s esophagus affects about 1 percent1 

of adults in the United States. The average age at diagnosis is 50, but determining 

when the problem started is usually difficult. 

Men develop Barrett’s esophagus twice as 

often as women, and Caucasian men are 

affected more frequently than men of other 

races. Barrett’s esophagus is uncommon in 

children. 

The Esophagus 

The esophagus carries food and liquids 

from the mouth to the stomach. The stomach slowly pumps the food and liquids into 

the intestine, which then absorbs needed 

nutrients. This process is automatic and 

people are usually not aware of it. People 

Digestive tract. 

sometimes feel their esophagus when they 

swallow something too large, try to eat too 

quickly, or drink very hot or cold liquids. 

The muscular layers of the esophagus are 

normally pinched together at both the 

upper and lower ends by muscles called 

sphincters. When a person swallows, the 

sphincters relax to allow food or drink to 

pass from the mouth into the stomach. The 

muscles then close rapidly to prevent the 

food or drink from leaking out of the stomach back into the esophagus and mouth. 

1

Cameron AJ. Epidemiology of Barrett’s esophagus 

and adenocarcinoma. Diseases of the Esophagus. 

2002;15:106–108. 
What is gastroesophageal 

reflux disease (GERD)? 

GERD is a more serious form of gastroesophageal reflux (GER). GER occurs 

when the lower esophageal sphincter opens 

spontaneously for varying periods of time 

or does not close properly and stomach 

contents rise into the esophagus. GER is 

also called acid reflux or acid regurgitation 

because digestive juices called acids rise 

with the food or fluid. 

When GER occurs, food or fluid can be 

tasted in the back of the mouth. When 

refluxed stomach acid touches the lining of 

the esophagus it may cause a burning sensation in the chest or throat called heartburn 

or acid indigestion. Occasional GER is 

common and does not necessarily mean one 

has GERD. 

Persistent reflux that occurs more than 

twice a week is considered GERD and can 

eventually lead to more serious health problems. Overall, 10 to 20 percent2

 of Americans experience GERD symptoms every 

day, making it one of the most common 

medical conditions. People of all ages can 

have GERD. 

2

El-Serag HB. Time trends of gastroesophageal reflux 

disease: a systematic review. Clinical Gastroenterology 

and Hepatology. 2007;5(1):17–26. 

GERD symptoms are often relieved by 

over-the-counter, acid-reducing agents 

called antacids. Common antacids include 

• Alka-Seltzer 

• Maalox 

• Mylanta 

• Pepto-Bismol 

• Riopan 

• Rolaids 

Other drugs used to relieve GERD 

symptoms are anti-secretory drugs such as 

H2 blockers and proton pump inhibitors. 

Common H2 blockers are 

• cimetidine (Tagamet HB) 

• famotidine (Pepcid AC) 

• nizatidine (Axid AR) 

• ranitidine (Zantac 75) 

Common proton pump inhibitors are 

• esomeprazole (Nexium) 

• lansoprazole (Prevacid)
 

• omeprazole (Prilosec, Zegerid)
 

• pantoprazole (Protonix) 

• rabeprazole (Aciphex) 

People who have GERD symptoms should 

consult with a physician. If GERD is left 

untreated over a long period of time, it 

can lead to complications such as a bleeding ulcer. Scars from tissue damage can 

lead to strictures—narrowed areas of the 

esophagus—that make swallowing difficult. 

GERD may also cause hoarseness, chronic 

cough, and conditions such as asthma. 

GERD and Barrett’s Esophagus 

The exact causes of Barrett’s esophagus are 

not known, but GERD is a risk factor for 

the condition. Although people who do not 

have GERD can have Barrett’s esophagus, 

the condition is found about three to five 

times more often in people who also have 

GERD. 

Since Barrett’s esophagus is more commonly seen in people with GERD, most 

physicians recommend treating GERD 

symptoms with acid-reducing drugs. 

2 Barrett’s Esophagus 
Improvement in GERD symptoms may 

lower the risk of developing Barrett’s esophagus. A surgical procedure may be recommended if medications are not effective in 

treating GERD. 

How is Barrett’s esophagus 

diagnosed? 

Because Barrett’s esophagus does not cause 

any symptoms, many physicians recommend that adults older than 40 who have 

had GERD for a number of years undergo 

an endoscopy and biopsies to check for the 

condition. 

Barrett’s esophagus can only be diagnosed 

using an upper gastrointestinal (GI) endoscopy to obtain biopsies of the esophagus. In 

an upper GI endoscopy, after the patient is 

sedated, the doctor inserts a flexible tube 

called an endoscope, which has a light and 

a miniature camera, into the esophagus. 

If the tissue appears suspicious, the doctor removes several small pieces using a 

pincher-like device that is passed through 

the endoscope. A pathologist examines the 

tissue with a microscope to determine the 

diagnosis. 

Normal esophagus. 

Barrett’s esophagus. 

What is the risk of 

esophageal cancer with 

Barrett’s esophagus? 

People with Barrett’s esophagus have a low 

risk of developing a kind of cancer called 

esophageal adenocarcinoma. Less than 

1 percent3

 of people with Barrett’s esophagus develop esophageal adenocarcinoma 

each year. Barrett’s esophagus may be present for several years before cancer develops. 

Esophageal adenocarcinoma is frequently 

not detected until its later stages when 

treatments are not always effective. 

Surveillance for Dysplasia 

and Cancer 

Periodic endoscopic examinations with 

biopsies to look for early warning signs 

of cancer are generally recommended for 

people who have Barrett’s esophagus. This 

approach is called surveillance. 

Typically, before esophageal cancer develops, precancerous cells appear in the 

Barrett’s tissue. This condition is called 

dysplasia and can be seen only through 

biopsies. Multiple biopsies must be taken 

because dysplasia can be missed in a single 

biopsy. Detecting and treating dysplasia 

may prevent cancer from developing. 

3

Shaheen N, Ransohoff DF. Gastroesophageal 

reflux, Barrett’s esophagus, and esophageal cancer. 

Journal of the American Medical Association. 

2002;287(15):1982–1986. 

3 Barrett’s Esophagus 
How is Barrett’s esophagus 

with dysplasia or cancer 

treated? 

Endoscopic or surgical treatments can 

be used to treat Barrett’s esophagus with 

severe dysplasia or cancer. Your doctor 

will present the available options and help 

determine the best course of treatment for 

you. 

Endoscopic Treatments 

Several endoscopic therapies are available 

to treat severe dysplasia and cancer. During these therapies, the Barrett’s lining is 

destroyed or the portion of the lining that 

has dysplasia or cancer is cut out. The goal 

of the treatment is to encourage normal 

esophageal tissue to replace the destroyed 

Barrett’s lining. Endoscopic therapies are 

performed at specialty centers by physicians 

with expertise in these procedures. 

• 	Photodynamic Therapy (PDT). PDT 

uses a light-sensitizing agent called 

Photofrin and a laser to kill precancerous and cancerous cells. Photofrin is 

injected into a vein and the patient 

returns 48 hours later. The laser light 

is then passed through the endoscope 

and activates the Photofrin to destroy 

Barrett’s tissue in the esophagus. 

Complications of PDT include chest 

pain, nausea, sun sensitivity for several 

weeks, and esophageal strictures. 

• 	Endoscopic Mucosal Resection 

(EMR). EMR involves lifting the 

Barrett’s lining and injecting a solution 

under it or applying suction to it and 

then cutting it off. The lining is then 

removed through the endoscope. If 

EMR is used to treat cancer, an endoscopic ultrasound is done first to make 

sure the cancer involves only the top 

layer of esophageal cells. The ultrasound uses sound waves that bounce 

off the walls of the esophagus to create 

a picture on a monitor. Complications 

of EMR can include bleeding or tearing of the esophagus. EMR is sometimes used in combination with PDT. 

Surgery 

Surgical removal of most of the esophagus 

is recommended if a person with Barrett’s 

esophagus is found to have severe dysplasia or cancer and can tolerate a surgical 

procedure. Many people with Barrett’s 

esophagus are older and have other medical 

problems that make surgery unwise; in these 

people, the less-invasive endoscopic treatments would be considered. Surgery soon 

after diagnosis of severe dysplasia or cancer 

may provide a person with the best chance 

for a cure. The type of surgery varies, but 

it usually involves removing most of the 

esophagus, pulling a portion of the stomach 

up into the chest, and attaching it to what 

remains of the esophagus. 

4 Barrett’s Esophagus 
 

Points to Remember 

• 	In Barrett’s esophagus, the tissue 

lining the esophagus is replaced by 

tissue that is similar to the lining of 

the intestine. 

• 	Barrett’s esophagus is associated 

with gastroesophageal reflux 

disease (GERD). 

• 	Improvement in GERD symptoms 

with acid-reducing drugs may 

decrease the risk of developing 

Barrett’s esophagus. 

• 	Barrett’s esophagus is diagnosed 

through an upper gastrointestinal 

endoscopy and biopsies. 

• 	People who have Barrett’s esophagus should have periodic surveillance endoscopies and biopsies. 

• 	Endoscopic treatments are used to 

destroy Barrett’s tissue, which will 

hopefully be replaced with normal 

esophageal tissue. 

• 	Removal of most of the esophagus 

is recommended if a person with 

Barrett’s esophagus is found to 

have severe dysplasia or cancer and 

can tolerate a surgical procedure. 

Hope through Research 

The National Institute for Diabetes and 

Digestive and Kidney Diseases and the 

National Cancer Institute sponsor research 

programs to investigate Barrett’s esophagus and esophageal adenocarcinoma. 

Further research into Barrett’s esophagus 

is needed, including 

• 	 establishing additional tests to identify 

people with Barrett’s esophagus 

• 	 identifying the cause(s) of Barrett’s 

esophagus 

• 	studying the long-term effectiveness 

of treatments such as PDT and EMR 

• developing additional nonsurgical 

treatments for people who have 

Barrett’s esophagus and dysplasia or 

cancer 

Participants in clinical trials can play a 

more active role in their own health care, 

gain access to new research treatments 

before they are widely available, and help 

others by contributing to medical research. 

For information about current studies, visit 

www.ClinicalTrials.gov. 

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory. 

5 	 Barrett’s Esophagus 
For More Information

American Gastroenterological Association

4930	Del	Ray	Avenue

Bethesda,	MD		20814

Phone:		301–654–2055

Fax:		301–654–5920

Email:		member@gastro.org

Internet:		www.gastro.org

International Foundation for Functional 

Gastrointestinal Disorders 

P.O.	Box	170864

Milwaukee,	WI		53217

Phone:		1–888–964–2001	or	414–964–1799

Fax:		414–964–7176

Email:		iffgd@iffgd.org

Internet:		www.iffgd.org

National Cancer Institute

National	Institutes	of	Health

6116	Executive	Boulevard,	Room	3036A		

Bethesda,	MD		20892–8322

Phone:		1–800–4–CANCER	(422–6237)

Fax:		301–496–0846

Email:		cancergovstaff@mail.nih.gov

Internet:		www.cancer.gov

You	may	also	find	additional	information	about	this	

topic	by	visiting	MedlinePlus	at	www.medlineplus.gov.

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Consult	your	doctor	for	more	information.

National Digestive Diseases 

Information Clearinghouse

2	Information	Way

Bethesda,	MD		20892–3570

Phone:		1–800–891–5389

TTY:		1–866–569–1162

Fax:		703–738–4929

Email:		nddic@info.niddk.nih.gov

Internet:		www.digestive.niddk.nih.gov

The	National	Digestive	Diseases	Information	Clearinghouse	(NDDIC)	is	a	service	

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Digestive	and	Kidney	Diseases	(NIDDK).		

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scientists	and	outside	experts.		This	fact	

sheet	was	originally	reviewed	by	G.	Richard	

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M.D.,	Cleveland	Clinic	Foundation.

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U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH	Publication	No.	08–4546

July	2008