Frequently Asked Questions About Barrett's Esophagus

For people with conditions affecting the esophagus (the tube that connects your mouth to your stomach), simply eating a meal can trigger uncomfortable symptoms. Here are some answers to some more frequently asked questions about Barrett's Esophagus:

Barrett's Esophagus Basics

Natural Remedies and Medication

Treatment and Esophageal Cancer

What is Barrett’s esophagus?

Barrett's esophagus, sometimes called Barrett's epithelium, refers to a change in the lining of the lower esophagus where the normal pinkish lining called the epithelium is replaced with a dark red lining called the intestinal metaplasia.

Is Barrett’s epithelium different from Barrett's esophagus?

For all practical purposes, Barrett's esophagus and Barrett's epithelium are the same thing.

What are the symptoms of Barrett’s esophagus?

Often, people with Barrett’s esophagus don’t have symptoms. If you have GERD, which can lead to Barrett’s esophagus, you may have symptoms of that disorder, including:

  • Frequent heartburn, which causes sharp pain in the chest and abdomen
  • Taste or feeling of stomach acid or partially digested food in the back of the mouth (regurgitation)
  • Difficulty swallowing

I was born with cells in my upper esophagus that secrete acid like stomach cells. Is this Barrett’s esophagus?

This is a condition called columnar mucosa in the upper esophagus. It is benign and doesn’t usually show symptoms. It is not associated with the subsequent development of esophageal cancer and is not Barrett’s esophagus.

How do I get rid of Barrett’s esophagus?

No standard treatment has proven to reverse or destroy Barrett's epithelium. This includes specialized treatments like bipolar probe, photodynamic therapy (PDT) and laser treatments, and general treatments like extended acid control (with omeprazole and lasoprazole) and Nissen fundoplication.

Could there be explanations for my symptoms other than Barrett’s esophagus?

There could be several possible explanations for your symptoms:

  • Post-nasal drip or sinus
  • Esophageal reflux of acid
  • An incoordination of the esophageal muscles

To exclude these various possibilities and to determine if there is specific therapy for your symptoms, you should speak to a gastroenterologist.

What foods make Barrett’s esophagus worse?

Certain foods can increase reflux by causing relaxation of the lower esophageal sphincter (LES). Things that can aggravate LES incompetence and reflux symptoms are:

  • Caffeinated, carbonated or alcoholic beverages
  • Tobacco
  • Fatty or fried foods
  • Mints
  • Chocolate
  • Coffee
  • Tomatoes or tomato products
  • Spicy foods

Foods that stay in the stomach longer (such as fried or fatty foods) tend to increase reflux symptoms and the amount of acid that enters the esophagus.

It is unclear whether "acidic" food cause increased acid production in the stomach. Although acidic food may worsen symptoms by irritating the already injured lining of the esophagus, they probably do not alter the severity or course of reflux disease and Barrett's esophagus.

What else should I avoid with Barrett’s esophagus?

Since reflux is more likely to occur when lying flat, raising the head of the bed prevents stomach fluid from flowing back into the esophagus. Generally, raising the bed four to six inches is recommended. Books or blocks under the legs of the bed or a wedge under the mattress can be used.

Since stomachs full of food and acid are more likely to reflux, avoiding bedtime snacks and eating meals at least three to four hours before lying down can help reduce reflux. The above measures will probably be more advantageous than abstaining from "acidic" food.

What medication options do I have for Barrett’s esophagus?

While medications cannot reverse Barrett’s esophagus, many medications can help relieve the symptoms. These are:

  • Proton pump inhibitors (PPIs) such as Prilosec and Prevacid to prevent stomach acid production
  • H2 receptor inhibitors such as Pepcid to reduce acid production
  • Antacids such as Rolaids and Mylanta to reduce acid in your stomach

You should ask you gastroenterologist about what medication may be the best for you.

Is it okay to use Prilosec for long periods to treat Barrett’s esophagus?

Omeprazole (Prilosec) has been used in patients with gastroesophageal reflux (GERD) in Europe for long periods of time (at least 3 to 5 years) without any apparent complications. The rationale for using omeprazole on a long-term basis is to prevent further acid damage to the lower esophagus and thereby limit esophagitis (inflammation of the esophagus) and control symptoms.

Is it safe to take Accutane with Barrett’s esophagus?

Accutane (isotretinoin) remains the most effective anti-acne therapy available. The most common side effects of Accutane are dryness of the mouth, nose and eyes. It also commonly produces some redness of the facial skin with increased sensitivity to ultraviolet light.

Despite the lack of specific information about the use of Accutane in patients with Barrett's esophagus taking Prilosec, it is probably safest to remain under the supervision of your Dermatologist.

Does long-term use of Pepcid affect testosterone levels?

Currently, there is no published data or literature to indicate that long-term use of Pepcid would affect male testosterone level or its biological function. If you are experiencing sexual dysfunction or other symptoms of testosterone loss, we recommend seeing your internist or endocrinologist regarding this issue.

How often should I be having endoscopies performed?

It is recommended that you have endoscopies every two years or so if you have intestinal metaplasia on the lower esophagus. It is necessary to biopsy this area because there is an increased chance of developing esophageal cancer.

Why do patients with Barrett's esophagus require repeated upper endoscopy?

Endoscopic surveillance is necessary because Barrett's esophagus can develop into a malignant neoplasm of the esophagus. Detection of early changes suggesting evolution into cancer will allow for treatment to be initiated.

Is the cell damage done to my esophagus reversible?

It is controversial whether Barrett's esophagus can revert to a normal lining (mucosa). Medical or surgical therapy, however, can heal the esophagitis or acute inflammation.

I have Barrett's esophagus with pre-cancer cells, what are my options?

The next step in your care depends on the degree of premalignant change. If you have low grade dysplasia, then higher doses of Prilosec or laser therapy is worth a try. If you have high grade dysplasia, you may want to consider surgery.

What are the symptoms for esophageal cancer?

Unfortunately, esophageal cancer symptoms may not be noticeable until the disease is advanced. Symptoms may include:

  • Difficulty swallowing, or a choking sensation when eating
  • Heartburn
  • Indigestion
  • Chest pain or pressure
  • Unexplained weight loss
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