Diagnosis

Endoscopy is generally used to determine if you have Barrett's esophagus.

A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing esophagus tissue. Normal esophagus tissue appears pale and glossy. In Barrett's esophagus, the tissue appears red and velvety.

Your doctor will remove tissue (biopsy) from your esophagus. The biopsied tissue can be examined to determine the degree of change.

Determining the degree of tissue change

A doctor who specializes in examining tissue in a laboratory (pathologist) determines the degree of dysplasia in your esophagus cells. Because it can be difficult to diagnose dysplasia in the esophagus, it's best to have two pathologists — with at least one who specializes in gastroenterology pathology — agree on your diagnosis. Your tissue may be classified as:

  • No dysplasia, if Barrett's esophagus is present but no precancerous changes are found in the cells.
  • Low-grade dysplasia, if cells show small signs of precancerous changes.
  • High-grade dysplasia, if cells show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.

Screening for Barrett's esophagus

The American College of Gastroenterology says screening may be recommended for men who have had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:

  • Being over 50
  • Being white
  • Having a lot of abdominal fat
  • Being a current or past smoker
  • Having a family history of Barrett's esophagus or esophageal cancer

While women are significantly less likely to have Barrett's esophagus, women should be screened if they have uncontrolled reflux or have other risk factors for Barrett's esophagus.

July 13, 2017
References
  1. Ferri FF. Barrett's esophagus. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed Feb. 17, 2017.
  2. Spechler SJ, et al. Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/home. Accessed Feb. 17, 2017.
  3. Shaheen NJ, et al. ACG clinical guideline: Diagnosis and management of Barrett's esophagus. American Journal of Gastroenterology. 2016;111:30.
  4. Barrett's Esophagus. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/barretts-esophagus/all-content. Accessed Feb. 19, 2017.
  5. Feldman M, et al. Barrett's esophagus. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Feb. 17, 2017.
  6. Hu Q, et al. Proton pump inhibitors do not reduce the risk of esophageal adenocarcinoma in patients with Barrett's esophagus: A systematic review and meta-analysis. PLoS One. 2017;12:1.
  7. Krishnamoorthi R, et al. Risk of recurrence of Barrett's esophagus after successful endoscopic therapy. Gastrointestinal Endoscopy. 2016;83:1090.
  8. Brown A. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Jan. 25, 2017.