WHAT IS BARRETT’S ESOPHAGUS?

Barrett’s esophagus is a precancerous disease that affects the lining of the esophagus.

BARRETT’S ESOPHAGUS

Barrett’s esophagus is a precancerous disease that affects the lining of the esophagus. It occurs when stomach acids and enzymes leak back into the esophagus. Over time, the chronic injury from the acid backwash cause the esophagus cells to change. It is common for a patient with untreated gastroesophageal reflux disease (GERD) to develop Barrett’s esophagus.1 Estimates suggest that over 95% of Barrett’s esophagus patients also have GERD.2

800,000 Canadians are living with Barrett's Esophagus - nearly half of these have no symptoms.3 Barrett’s esophagus is the primary risk factor for esophageal cancer and can increase a person’s risk by 50 times or more.4-7

Infographic depicting the risk of esophageal cancer in Barrett's esophagus patients.

BARRETT’S ESOPHAGUS SYMPTOMS

People with Barrett’s esophagus may not experience any symptoms.8 However, chronic heartburn, difficulty swallowing, nausea, chest pain, and other symptoms of GERD may indicate a need for further testing.

In addition to suffering from chronic heartburn, other factors that may put a person at risk for Barrett’s esophagus include:9

  • Obesity
  • Caucasian ethnicity
  • Family history
  • Male gender

To know for sure if you have Barrett’s esophagus, consult a gastroenterologist (GI). Barrett’s esophagus cannot be diagnosed by symptoms alone. Diagnosing Barrett’s is dependent on an upper endoscopy.

Sitting in kitchen, man coughs while next to his wife.

DISEASE PROGRESSION AND COMPLICATIONS

Barrett’s esophagus can progress to more serious stages, potentially resulting in esophageal adenocarcinoma, a type of esophageal cancer.5,6,10

There are three stages of Barrett’s esophagus, which range from intestinal metaplasia without dysplasia to high-grade dysplasia. Dysplasia signifies the presence of abnormal cell growth within bodily tissue. The presence of dysplasia is not considered cancer but may increase the risk of developing cancer, so medical guidelines recommend treatment.11,12

  • Intestinal Metaplasia Without Dysplasia: Barrett’s esophagus is present, but no precancerous changes are visible in the cells of your esophageal lining.
  • Low-Grade Dysplasia: Cells show early signs of precancerous changes that could lead to esophageal cancer.
  • High-Grade Dysplasia: Esophagus cells display a high degree of precancerous changes, thought to be the final step before esophageal cancer.

Stages of Barrett's Esophagus

  1. Normal, healthy esophagus
  2. Esophagus damaged by prolonged acid exposure
  3. Barrett's esophagus tissue
  4. Dysplastic Barrett's esophagus
  5. Esophageal adenocarcinoma
Illustration of the various stages of esophageal damage caused by GERD, Barrett's esophagus and esophageal cancer.

ESOPHAGEAL ADENOCARCINOMA

Cancer occurs when the abnormal cells involved in Barrett’s esophagus engage in rapid and uncontrolled growth and invade the deeper layers of your esophagus. This type of esophageal cancer is called esophageal adenocarcinoma (EAC) and it can spread beyond the esophagus.

Although cancers of the esophagus are still relativelt rare in Canada, the incidence rate for esophageal adenocarcinoma has doubled in the last two decades. Similar increases have been observed in Englad, New Zealand, Australia, and pats of Europe.  Patients with Barrett’s esophagus are 30 to 125 times more at risk of developing EAC than patients without the condition.13 Only 14% of patients survive at least five years after the diagnosis of esophageal cancer.14

The good news is that there is treatment available. Radiofrequency ablation has been shown to eradicate Barrett’s esophagus and significantly reduce the risk of progression to high-grade dysplasia and esophageal adenocarcinoma.8,13,15


Information and resources on this site should not be used as a substitute for medical advice from your doctor. Always discuss diagnosis and treatment information including risks with your doctor. Keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary.

1

Dymedex Market Development Consulting, Strategic Market Assessment, Barrx, October 30, 2014. References 1, 3-5, 7-13, 15, 16, 20-23, 25, 27-29, 40-44, 46, 48-50, 54-59, 62-66, 68-75, 78, 79, 81, 82, 87-89, and 97 from the full citation list, access at http://www.medtronic.com/giclaims

2

Spechler SJ. Barrett’s esophagus. N Engl J Med. 2002;346(11):836-42.

3

CDHF, https://cdhf.ca/digestive-disorders/barretts-esophagus/barretts-esophagus/

4

SEER Cancer Statistics Factsheets: Esophageal Cancer. National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/statfacts/html/esoph.html.

5

De Jonge PJ, van Blankenstein M, Looman CW, Casparie MK, Meijer GA, Kuipers EJ. Risk of malignant progression in patients with Barrett’s oesophagus: a Dutch nationwide cohort study. Gut. 2010;59:1030-6.

6

Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365:1375-83.

7

Wani S, Falk G, Hall M, Gaddam S, Wang A, Gupta N, et al. Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2011;9(3):220-7.

8

Shaheen NJ, Richter JE. Barrett’s oesophagus. Lancet. 2009;373(9666):850-61.

9

Spechler SJ, Souza RF. Barrett’s esophagus. NEJM. 2014;371:836-45.

10

Pohl H, Welch HG. The role of over diagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97:142-6.

11

Shaheen NJ, Falk GW, Iyer PG, Gerson LB. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. The American Journal Of Gastroenterology. 2016;111(1):30-50. doi:10.1038/ajg.2015.322.

12

Wani S, Qumseya B, Sultan S, et al. Endoscopic eradication therapy for patients with Barrett’s esophagus-associated dysplasia and intramucosal cancer. Gastrointestinal Endoscopy. 2018;87(4):907-931.

13

Eisen GM. Ablation therapy for Barrett's esophagus. Gastrointestinal Endosc. 2003;58:760-9.

14

Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2017. Available at: cancer.ca/Canadian-CancerStatistics-2017-EN.pdf (accessed March 1, 2019)

15

Wolf WA, Pasricha S, Cotton C, Li N, Triadafilopoulos G, Raman Muthusamy V, et al.  Incidence of Esophageal Adenocarcinoma and Causes of Mortality After Radiofrequency Ablation of Barrett’s Esophagus. Gastroenterology. 2015;149(7):1752-1761.

*

Canadian Cancer Society’s Advisory Committee on Cancer Statistics. Canadian Cancer Statistics 2017. Available at: cancer.ca/Canadian-CancerStatistics-2017-EN.pdf (accessed March 1, 2019)