Treatment of Barrett’s Esophagus

This content has been reviewed and approved by

Chandra P. Belani, MD
Deputy Director, Penn State Cancer Institute
Miriam Beckner Professor of Medicine
Penn State University School of Medicine

Barrett's esophagus is a precancerous condition of the esophagus characterized by the abnormal cells in the surface lining of the lower esophagus.

The following is a general overview of the treatment of Barrett’s esophagus with or without associated dysplasia. The information on this website is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Screening - About 1 to 2 percent of the adult population have Barrett’s esophagus. If you have this condition, your doctor will consider a screening program to detect dysplasia or cancer. The goal of screening is to detect cancer early when it can be cured with surgery.

Screening usually requires endoscopic examination with routine biopsies every 6 months to 2 years. An endoscope is a thin, flexible, lighted tube that your physician guides into your mouth and throat, then into the esophagus, and sometimes into the stomach, and duodenum (the first part of the small intestine that connects to the stomach). The endoscope allows your physician to view the inside of this area of your body, as well as to insert instruments through a scope to remove a tissue sample for biopsy.

Treatment goals - In patients with Barrett’s esophagus without dysplasia, the idea is to prevent reflux and/or to eradicate the abnormal cells to encourage normal, squamous cells to grow. In patients with low-grade dysplasia, the idea is to try and halt the progression to high-grade dysplasia. Patients with low-grade dysplasia do not develop invasive cancer without progressing to high-grade dysplasia first. In patients with high-grade dysplasia, the usual treatment is an operation to remove part of the esophagus. This is called an esophagectomy. There is a high cure rate with surgery.

• Barrett's esophagus without dysplasia - There have been many attempts to treat the reflux associated with Barrett’s esophagus in hope of preventing dysplasia, which leads to adenocarcinoma. These treatments range from intensive antacid therapy to surgical procedures to correct reflux. There is very little evidence that intensive antacid therapy prevents progression to dysplasia or controls reflux. However, there is evidence that surgical correction of reflux may be of benefit both in reducing symptoms and possibly in reducing the extent of Barrett’s esophagus and the evolution to dysplasia.
• Barrett's esophagus with low-grade dysplasia - Antireflux surgery may prevent or reverse the development of low-grade dysplasia associated with Barrett’s esophagus. In addition, researchers have evaluated techniques, such as photodynamic treatments with a laser and the delivery of heat to coagulate cells, in an effort to eradicate low-grade dysplasia.
• High-grade dysplasia - The treatment of choice for patients with Barrett’s esophagus that has progressed to high-grade dysplasia is esophagectomy (surgically removing the esophagus).

Patients with Barrett’s esophagus with high-grade dysplasia who are treated with early surgery may have a better chance of a cure than patients who wait until the biopsy shows invasive cancer. However, it is important to have the diagnosis of high-grade dysplasia confirmed by at least two pathologists since this is a difficult diagnosis to make, and removing the esophagus is major surgery.

The cure rate following an esophagectomy for patients with high-grade dysplasia is more than 90 percent. The cure rate for patients with adenocarcinoma depends on the stage at diagnosis.

Since some patients with high-grade dysplasia will not be well enough to undergo esophagectomy, other treatments such as photodynamic laser treatments and various forms of delivering heat can be used to kill the dysplastic cells. Although these treatments have a significant effect on high-grade dysplasia, it is still unclear whether or not they prevent progression to cancer.

Most new treatments come about through clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Developing more effective cancer treatments requires cancer patients to help evaluate these new and innovative therapies.

Participating in a clinical trial may offer you access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. If you’re interested in participating in a clinical trial, you should discuss the risks and benefits of clinical trials with your physician. To ensure that you’re receiving the optimal treatment for your cancer, it is important to stay informed and follow the cancer news to learn about new treatments and clinical trial results.

For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.