Frequently asked questions about Barrett's esophagus

1. Should I tell my doctor about my heartburn even though it's better since I started a medication that I can buy without a prescription? Yes. Chronic heartburn is a strong risk factor for Barrett's esophagus and for the development esophageal adenocarcinoma (a type of esophageal cancer) whether your heartburn gets better on medication or just goes away without any treatment.
see sections Could I have Barrett's esophagus? and What causes Barrett's esophagus?

2. I recently heard about a procedure to treat heartburn that is performed through the endoscope, without surgery. Is there a good chance that I can come off of my heartburn medication if I have it? There are now several FDA approved procedures aimed at controlling heartburn that can be performed through the endoscope. The short-term studies looked promising, but the long-term outcome is unknown. Although many patients have been treated worldwide, it has not been reported how most of these patients are doing. Based on reports of how well patients are doing 6 to 12 months after they have such a procedure, between 58% and 85% of patients say they have been able to stop their acid controlling medication and that their heartburn has improved. However, in most patients, tests that measure esophageal acid exposure have not become normal and patients with esophagitis (inflammation of the esophagus from acid and bile reflux) have not had healing of their esophagitis. Patients who have Barrett's esophagus, severe esophagitis (inflammation of the esophagus), or a large hiatal hernia have been excluded in most cases from undergoing these procedures so there is little information concerning use of these therapies in these patients. Although severe side-effects are not common, they have occurred, even death. Recently, one endoscopic procedure, the ENTERYX® procedure, is no longer being performed because the manufacturer has withdrawn the injection kit from the market due to some serious side effects. It will be a few more years before enough patients have had these procedures to know how well they control heartburn or if there are any long-term problems with them. At the present time, many hearburn experts believe that anyone who has one of these procedures should consider it experimental.
see section Endoscopic therapies for GERD

3. What is the recommended diet for patients who have Barrett's esophagus? The same diet that is recommended to patients who have heartburn without Barrett's esophagus. Patients should eat a diet low in fat and stay away from any food that they know triggers their heartburn symptoms. Some examples of common heartburn triggers are tomato sauce, orange juice and carbonated sodas. Also, certain foods, such as chocolate and peppermint may also lead to heartburn by relaxing the lower esophageal valve and probably should be avoided. The evening meal should be small and it is best not to eat or drink anything except water for several hours before bedtime. Five or more servings (cups) of fruits and vegetables are recommended as this diet may be associated with a lower risk of developing some cancers, although this is unproven.
see section, How is GERD treated and follow the link for Life-style changes

4. I have Barrett's esophagus and several of my family members have heartburn. Can Barrett's esophagus run in families? There are families in which more than one member has Barrett's esophagus, or esophageal adenocarcinoma, but since most people who have Barrett's esophagus go undiagnosed, there may be many more families that we don't know about. One study has shown that more family members of people who have Barrett's esophagus have heartburn as compared to family members of people who do not have Barrett's esophagus. Certainly anyone who has a problem with heartburn and has a family member with Barrett's esophagus or esophageal adenocarcinoma needs to have their esophagus checked for Barrett's esophagus by upper endoscopy with biopsy.
see section, Who gets Barrett's Esophagus and Could I have it?

5. I have recently been diagnosed with Barrett's esophagus. How often should I have an upper endoscopy with biopsy (endoscopic biopsy surveillance)? The American College of Gastroenterology (ACG) guidelines for the management of Barrett's esophagus suggest that the frequency of patient endoscopies should be based on the histologic readings of their biopsies (tissue analysis under the microscope). Based on the most current ACG guidelines, for patients who have a diagnosis of negative for dysplasia, endoscopy with biopsy should be performed every 3 years. For those who have a diagnosis of stable low-grade dysplasia (an abnormal growth pattern of the Barrett's cells) confirmed by two procedures, endoscopy should be performed yearly. For patients who have a diagnosis of high-grade dysplasia (a severe abnormality in the growth pattern of the Barrett's cells) and who do not get their esophagus surgically removed, endoscopy with biopsy should be repeated to check for cancer that may have been missed with the first endoscopy. If no cancer is detected, then surveillance should be performed every 3 months. Ablation therapy (destruction of the Barrett's lining performed without surgery) or other ablation therapy may also be considered in patients who have high-grade dysplasia, but endoscopic biopsy surveillance must continue after the treatment. Most experts agree that patients who have a diagnosis of high-grade dysplasia should be referred to a specialty center with doctors experienced in esophageal surgery, endoscopic therapy and endoscopic biopsy surveillance of these patients. The ACG guidelines are somewhat arbitrary because there are no strong scientific studies to support them but rather they are based on our current understanding of how cancer develops in Barrett's esophagus, so your doctor may suggest different surveillance intervals. For most patients who have Barrett's esophagus without high-grade dysplasia, these recommendations are more frequent than they need to be because most never develop cancer. How to better determine who with Barrett's esophagus will ultimately develop cancer and how long patients can go between endoscopies is an area of active research.
see sections What is Endoscopic Biopsy Surveillance?, Are there any non-surgical treatments for Barrett's, and What is Flow Cytometry?

6. My doctor suggests that I have anti-reflux surgery because I have Barrett's esophagus. Will that surgery prevent cancer from developing in Barrett's? There are no good studies supporting the use of anti-reflux surgery or heartburn medication to prevent cancer in Barrett's esophagus. At the present time, anti-reflux surgery is an accepted treatment option for heartburn or esophagitis (inflammation from acid reflux into the esophagus) and should not be viewed as a cancer prevention treatment.
see section, How is GERD Treated? and follow the link for anti-reflux surgical therapy.

7. What percent of people with Barrett's esophagus get cancer? Most patients who have Barrett's esophagus live out their lives without developing cancer and die of other causes. The risk of developing cancer (esophageal adenocarcinoma) in Barrett's esophagus is low, estimated to be between 5-10% and most patients who have Barrett's esophagus do not die from esophageal cancer. However, patients with Barrett's esophagus have more than a 40-fold increase in cancer risk as compared to the general population and that is why periodic upper endoscopy with biopsy (endoscopic biopsy surveillance) to check for cancer is recommended.
see section, If I have Barrett's Esophagus, Will I Get Cancer?

8. I have been diagnosed with Barrett's esophagus but I feel fine. Why do I need endoscopy with biopsy if I don't have any symptoms of cancer? You need periodic endoscopic biopsy surveillance of your Barrett's esophagus in order to catch the cancer early, if it develops, before you have symptoms. Cancer diagnosed early, when it is very small, too small to cause symptoms, has a high likelihood of a cure with surgery. Additionally, there is evidence that early cancer may be successfully treated using endoscopic therapies without surgery, especially important in patients who are elderly or not medically fit to undergo the surgery.  However, cancer diagnosed when large enough to cause symptoms is much less likely to be cured. By the time most people have symptoms of cancer, they usually have a large cancer that is much more difficult to successfully treat.
see section, What are the treatments for cancer in Barrett's Esophagus?

9. Is there anything that I can do to prevent cancer from developing in my Barrett's esophagus? There is no proven way to completely eliminate the risk of developing cancer in Barrett's esophagus. Heartburn medications as well as anti-reflux surgery control heartburn symptoms but are not proven to make Barrett's esophagus completely disappear or prevent cancer from developing in Barrett's esophagus. Ablation therapies, endoscopic therapies that destroy or remove the Barrett's lining, are also unproven to completely eliminate the risk of cancer in Barrett's esophagus. Fortunately, most patients who have Barrett's esophagus will not develop cancer. At the present time, controlling heartburn symptoms with medication or anti-reflux surgery, and getting your esophagus periodically checked for cancer is recommended for most patients who have Barrett’s esophagus. As smoking may increase your risk of developing esophageal cancer, it is recommended that you stop smoking. Modest weight loss and eating a diet high in fruits and vegetables and low in fat may also reduce your risk of cancer, but is unproven.
see sections If I have Barrett's esophagus, will I get cancer? and Is there a cure for my Barrett's esophagus?

10. Last year my biopsies were read as negative for dysplasia and recently they were read as low-grade dysplasia. Does this mean that my Barrett's esophagus is progressing to high-grade dysplasia or cancer? No. Biopsy readings may vary from time-to-time for many reasons including a pathologist's interpretation of the severity of the dysplasia (abnormal growth pattern of the Barrett's cells) or even inflammation from acid reflux. Although the American College of Gastroenterology recommends more frequent endoscopic biopsy surveillance for a diagnosis of low-grade dysplasia, the diagnosis of low-grade dysplasia has not been very useful in predicting who will progress to cancer in Barrett's esophagus. Most patients who have low-grade dysplasia do not develop cancer. In fact, high-grade dysplasia, confirmed by an experienced GI pathologist, is the only histologic diagnosis that has been shown to be useful in predicting who will develop cancer, although many patients with a diagnosis of high-grade dysplasia do not progress to cancer. Another test, called flow cytometry (measures the amount of DNA in cells) may help separate higher-risk from lower-risk patients. Flow cytometry is not currently in widespread use in Barrett's esophagus. At the present time, in the absence of any test but histology, your doctor may recommend more frequent endoscopy for a diagnosis of low-grade dysplasia, based on the current American College of Physician Guidelines.
see sections, What is Endoscopic Biopsy Surveillance? and What is Flow Cytometry?

11. I have just been diagnosed with high-grade dysplasia and my doctor recommends that I have my esophagus out. How do I know if this is the right treatment? Esophagectomy, surgical removal of the esophagus is a standard recommended treatment for high-grade dysplasia. It is the recommended treatment because of studies showing that small cancers can be missed through the endoscope and that a significant number of patients who have their esophagus out for high-grade dysplasia actually have cancer when their esophagus is examined after surgical removal. There are now other options for management of high-grade dysplasia, such as endoscopic therapies. Because not all patients who have high-grade dysplasia develop cancer and esophagectomy carries with it a higher risk of death as compared to most gastrointestinal surgeries, a third option for you is to remain in close endoscopic biopsy surveillance, reserving esophagectomy or endoscopic therapy for cancer if it develops.  If you decide to have your esophagus out for a diagnosis of high-grade dysplasia, it is recommended that you undergo a second endoscopic biopsy surveillance procedure and have an experienced GI pathologist read all of your biopsy slides to confirm the diagnosis BEFORE you have the surgery. In addition, you should have your esophagectomy performed by an experienced esophageal surgeon who has a mortality (rate of death) of 5% or less and who operates in a large volume specialty center experienced in taking care of patients who have Barrett's high-grade dysplasia and cancer. Because the diagnosis of high-grade dysplasia is uncommon, most community-based physicians do not get the opportunity to care for many of these patients. Most of the experience in the care of these patients is concentrated in medical centers that receive referrals of patients who have high-grade dysplasia. Therefore, whether you wish to remain in endoscopic biopsy surveillance, undergo endoscopic therapy, or esophagectomy, most Barrett’s experts would recommend that you be referred to a large volume specialty center with gastroenterologists, pathologists and surgeons experienced in the counseling and care of patients who have high-grade dysplasia.

see section, What are the treatment options for high-grade dysplasia in Barrett's?

12. I have high-grade dysplasia and I really don't want to have my esophagus removed or come back for endoscopies so often to check for cancer. Can't I just have my Barrett's lining burned off with one of those ablation treatments so that I can get rid of the high-grade dysplasia and not have to keep coming back for all those endoscopies? Esophagectomy, surgical removal of the esophagus, is the only way that you can safely avoid undergoing periodic endoscopic biopsy surveillance of your Barrett's esophagus. If you have high-grade dysplasia and do not have an esophagectomy, you should remain in endoscopic biopsy surveillance indefinitely, whether or not you have ablation therapy. This is because ablation therapy has not been shown to completely eliminate the risk of developing cancer. For this reason, the Barrett's esophagus ablation experts are NOT recommending, at this point, that endoscopic surveillance be discontinued after ablation therapy. Endoscopic biopsy surveillance is the only way to detect a cancer, if it develops, before it becomes large and much less curable.
see section, What are some non-surgical therapies for Barrett's Esophagus?