Confirming Barrett’s Esophagus
Your doctor may suspect Barrett’s esophagus based upon your symptoms and risk factors (see sidebar). An endoscopy is  needed to confirm the presence of abnormal cells in the  esophageal lining. Endoscopy is the most effective detector of Barrett’s esophagus, finding it 80 percent of the time. “Many physicians recommend that adults who are over the age of 40 and have had GERD symptoms for a number of years have an endoscopy regularly,” says Suneja.

To do an endoscopy, the doctor gently guides a long thin tube through the mouth and into the esophagus. This procedure is usually done under anesthesia with little or no discomfort. The scope contains instruments that allow the doctor to see the lining of the esophagus directly and do a biopsy (removing small tissue samples). The biopsy will be examined in a lab to see whether the cells’ structure has changed.

Once the cells in the lining have changed, they will not revert back to normal. There is no cure for Barrett’s esophagus. That’s why it is critical for your doctor to do two things regularly: provide treatment to prevent any further damage from acid reflux and perform regular endoscopies to monitor future cell changes. For the latter, an endoscopy is recommended by most doctors every six to twelve months.

Treatment
The priority in treating Barrett’s esophagus is to stop ongoing damage of the esophageal lining. One step is eliminating foods that can worsen reflux, including: chocolate, coffee, tea, peppermint, alcohol, acidic juices, and fatty foods.

Medications that are helpful are H2 blockers like cimetidine (Tagamet); ranitidine (Zantac) and famotidine (Pepcid), and proton pump inhibitors like omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid). All of them reduce the amount of acid produced by the stomach.

If these medications do not work, surgery to remove the damaged tissue may be necessary.

The More Serious Danger
In and of itself, Barrett’s esophagus isn’t that dangerous. Its main danger comes because it can be a precursor to esophageal cancer. Although one of the rarest cancers in Western countries, the incidence of esophageal cancer has doubled in America in the last decade. “The risk of developing cancer is 30 to 125 times higher in people who have Barrett’s esophagus than in people who do not. The good news is even then the risk of  getting cancer of the esophagus is small: less than 1 percent of people with Barrett’s esophagus develop cancer each year,” says Suneja.

The main treatment for esophageal cancer is a very complex  surgery, in which the entire esophagus is removed and replaced with an artificial tube. Then the stomach is pulled up into the chest and attached to the bottom of the tube.

Because  esophageal cancer often doesn’t develop until later in life, people who develop it tend to have multiple medical conditions. For this and other reasons, it is often found to be unwise to perform this surgery on people with esophageal  cancer. Of the 13,400 people diagnosed with it every year, 11,300 will die. That is why it is critical to keep a close watch on Barrett’s esophagus and keep it from progressing to this stage.

The good news is Barrett’s esophagus doesn’t have to lead to cancer. In fact, it is uncommon with proper treatment. With appropriate medication and  monitoring, people rarely die from Barrett’s esophagus or its consequences.

• Age—Barrett’s esophagus is most commonly diagnosed in middle-aged and older adults; the average age at diagnosis is 55 years.

• Gender—Men are more commonly diagnosed with Barrett’s  esophagus than women.

• Ethnic background—Barrett’s esophagus is equally common in European-American and Latino populations, and uncommon in African-American and Asian populations.

• Lifestyle—Smokers are more commonly diagnosed with Barrett’s esophagus than nonsmokers.