Barrett’s Advice

This site is dedicated to the discussion of an important medical condition known as Barrett’s esophagus (BE). Generally speaking, the only people that seem to know about Barrett’s are those who have the condition. The truth is anyone suffering from chronic reflux or GERD is at risk for this silent but potentially deadly disease.

Esophageal cancer or adenocarcinoma of the esophagus is one of the fastest growing cancers in the United States and is directly associated with heartburn and Barrett’s esophagus. It is estimated that up to 20% of the US population suffers from heartburn symptoms and that several million Americans have Barrett’s. Barrett’s esophagus results from a mutation in the lining of the lower esophagus caused by years of acid reflux. Barrett’s may be the body’s attempt to adapt to reflux as it appears to have increased resistance to acid injury. Barrett’s produces no noticeable symptoms, and quite the opposite, often results in an improvement in heartburn complaints. Ironically, a patient whose heartburn has unexpectedly improved may in fact be at increased risk for Barrett’s esophagus.

Individuals with heartburn should understand their need for appropriate medical screening. A sub-specialist in gastrointestinal diseases (gastroenterologist) will usually make the diagnosis of Barrett’s during an upper endoscopy. The discovery of Barrett’s esophagus is actually a fairly routine occurrence particularly in white males with longstanding heartburn, 40-60 years old. The diagnosis is made after an upper endoscopy and biopsy of the esophageal lining. Most patients are shocked when informed they have Barrett’s esophagus, and often become quite alarmed upon learning of their small, but not insignificant risk of esophageal cancer.

So, why this website? Very few patients or, even doctors, have an adequate understanding of Barrett’s esophagus, and finding reliable, up-to-date information or useful advice is not an easy task. Every patient with Barrett’s has some risk of esophageal cancer, but how high is the risk, what are the factors that lead to increased risk, how can I reduce my risk? These are all very important questions and answering those questions in a way that the "average person" can understand is the mission of this site. 

To begin, there are a number of important medical terms used to describe Barrett’s that you need to understand such as, dysplasia, high grade dysplasia, intestinal metaplasia, short segment Barrett’s, long segment Barrett’s and adenocarcinoma -it is truly mind-boggling!!! Lifestyle and environmental factors may also contribute to esophageal cancer risk. Some of these risk factors can be reduced with appropriate measures such as weight loss, exercise, proper diet, and possibly vitamin supplements. Controlling chronic heartburn / GERD (gastro esophageal reflux disease) is also very important since it is the primary cause of Barrett’s esophagus. Uncontrolled reflux may result in higher cancer risk.

It is also important for you to know there are different strategies in managing Barrett’s esophagus. A more traditional approach, also known as "endoscopic surveillance" relies on periodic check ups with upper endoscopy and heavy sampling of the esophageal lining.  In the traditional approach to Barrett’s, treatment (surgery) is only recommended after cancerous changes appear within the Barrett’s. However, an alternative to the traditional approach is the "early treatment" strategy and involves removal of the abnormal Barrett’s lining before cancerous changes have occurred. This new technique known as "endoscopic ablation" offers an interesting option that is well suited for patients uncomfortable with the idea of "following" their Barrett’s. Although endoscopic ablation is a relatively new technology, early reports from doctors and patients have been very encouraging. News reports and media attention are thankfully raising awareness of Barrett’s and new technologies to treat this condition should continue to improve in their effectiveness.

Be prepared for conflicting medical opinions regarding Barrett’s management. Many physicians will argue for the more established "traditional" approach to Barrett’s and oppose early treatment, while others feel just as strongly about early removal of Barrett’s with endoscopic ablation. In the end, the decision is yours and should be based on a good understanding of the advantages and disadvantages associated with each strategy. 

In summary, this site has two major goals - to lower your chances of developing esophageal cancer and to reduce the symptoms and potential complications of chronic reflux. Education and early awareness are the keys to controlling heartburn and preventing Barrett’s from becoming esophageal cancer. By reading our articles, watching treatment videos, and participating in the "discussion forum" and "Live Barretts Chat" room, you will have a much more complete understanding of Barrett’s esophagus and its management.

By the way, we also want to hear from you about your experiences with Barrett’s and chronic reflux. Everyone can learn from someone who is ‘in the same boat’ and how they are approaching these problems.  Everyday thousands are diagnosed with Barrett’s esophagus and need not only good information, but a lot of personal support. Letting others learn from your experiences with Barrett’s, good or bad, is invaluable. We would all appreciate hearing from you… so please, everyone feel free to share with us in the discussion room and in the Live Barrett’s Chat Room. Finally, this site is only a resource, it is not meant to replace the advice of your own doctor. Always review any medical information found on this site with your personal physician.

                                                        Best of health to you all,

                                                                      William D. Lyday, MD
                                                                      Editor in Chief