Your treatment options for Barrett's esophagus depend on whether high-grade or low-grade dysplasia is found in the cells of your esophagus, your overall health and your own preferences.
Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:
Periodic endoscopy exams to monitor the cells in your esophagus. How often you undergo endoscopy exams will depend on your situation. Typically, if your biopsies show no dysplasia, you'll have a follow-up endoscopy one year later. If your doctor again detects no dysplasia, your doctor will likely recommend endoscopy exams every three years. If low-grade dysplasia is detected, your doctor may recommend GERD treatments and another endoscopy in six months or a year. If you're determined to have high-grade dysplasia, then your doctor may offer other treatment options.
Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.
- Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find prescription medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. One such procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.
Treatment for people with high-grade dysplasia
High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:
- Surgery to remove the esophagus. During an esophagectomy, the surgeon removes most of your esophagus and attaches your stomach to the remaining portion. Surgery carries a risk of significant complications, such as bleeding, infection and leaking from the area where the esophagus and stomach are joined. When esophagectomy is performed by an experienced surgeon, there's a reduced risk of complications. Still, because of the potential complications of this major operation, other treatments are usually preferred over surgery. One advantage to surgery is that it reduces the need for periodic endoscopy exams in the future.
- Removing damaged cells with an endoscope. Endoscopic mucosal resection is used to remove areas of damaged cells using an endoscope. Your doctor guides the endoscope down your throat and into your esophagus. Special surgical tools are passed through the tube. The tools allow your doctor to cut away the superficial layers of the esophagus and remove damaged cells. Endoscopic mucosal resection carries a risk of complications, such as bleeding, rupture and narrowing of the esophagus.
- Using heat to remove abnormal esophageal tissue. Radiofrequency ablation involves inserting a balloon filled with electrodes in the esophagus. The balloon emits a short burst of energy that destroys the damaged esophageal tissue. Radiofrequency ablation carries a risk of narrowing of the esophagus, bleeding and chest pain.
- Using cold to destroy abnormal esophagus cells. Cryotherapy involves using an endoscope to apply a cold liquid or gas to the abnormal cells in the esophagus. The cells are allowed to warm up and then are frozen again. The cycle of freezing and thawing damages the cells. Cryotherapy carries a risk of chest pain, narrowing of the esophagus and tearing of the esophagus.
- Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain and nausea.
If you undergo treatment other than surgery to remove your esophagus, there's a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.
May. 25, 2011
- Spechler SJ, et al. Barrett's esophagus. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed March 25, 2011.
- Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Bethesda, Md.: American College of Gastroenterology. http://www.acg.gi.org/physicians/guidelines/BarrettsEsophagus08.pdf. Accessed March 25, 2011.
- Azodo IA, et al. Barrett's esophagus. American College of Gastroenterology. http://www.acg.gi.org/patients/gihealth/barretts.asp. Accessed March 25, 2011.
- Spechler SJ, et al. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology. 2011;140:1084.
- Barrett's esophagus. National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm. Accessed March 25, 2011.
- Crockett SD, et al. Health-related quality of life in patients with Barrett's esophagus: A systematic review. Clinical Gastroenterology and Hepatology. 2009;7:613.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Institute of Diabetes and Digestive and Kidney Diseases. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm. Accessed March 28, 2011.
- Greenwald BD, et al. Cryotherapy for Barrett's esophagus and esophageal cancer. Current Opinion in Gastroenterology. In press. Accessed May 23, 2011.
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