Diagnosing Barrett’s Esophagus
NYU Langone doctors are experts in diagnosing Barrett’s esophagus, a condition in which precancerous changes occur in the cells that line the esophagus, the muscular tube that carries food and liquids from the mouth to the stomach.
Normally, the esophagus is lined with squamous cells—flat, square cells that give the tissue a pale pink, smooth appearance. In Barrett’s esophagus, these cells become salmon-colored and column-shaped, similar to those found in the intestines.
Causes and Symptoms
The exact cause of Barrett’s esophagus is not completely understood. However, doctors suspect the key culprit is repeated exposure to stomach acid caused by gastroesophageal reflux disease, or GERD. In this condition, acid and other stomach contents flow back into the esophagus. As a result, tissue lining the esophagus may be injured. This can lead to esophagitis, an inflammation of the esophagus, or precancerous changes that increase the risk of esophageal cancer.
Only a small percentage of people with GERD develop Barrett’s esophagus. Among those who have the condition, only a small percentage are diagnosed with esophageal cancer.
Many people who have GERD, Barrett’s esophagus, or both experience symptoms such as heartburn, or a burning sensation in the chest; sore throat; cough; hoarseness; difficulty swallowing; or chest pain. However, many people with these conditions do not experience any symptoms.
Barrett’s esophagus tends to be more common in white men aged 50 or older and in people who are overweight or obese and carry extra weight around the abdomen. Having a hiatal hernia also raises the risk of developing Barrett’s esophagus. A hiatal hernia causes the upper portion of the stomach to bulge into the chest cavity through an opening, or hiatus, in the diaphragm—the muscular wall that separates the chest and abdomen.
Researchers are exploring the role of genetics in a person’s risk of developing Barrett’s esophagus.
Most of the time, Barrett’s esophagus cells pose no health risk. But in a small percentage of people, they may become precancerous. This is called dysplasia. People who have dysplastic esophageal cells are at increased risk of developing a form of cancer called esophageal adenocarcinoma, which has become more prevalent in the past several decades.
Dysplasia is classified as low-grade or high-grade. In low-grade dysplasia, the cells are abnormal but are at low risk of becoming cancerous and spreading. In high-grade dysplasia, the cells are likely to become cancerous and spread.
To diagnose Barrett’s esophagus, an NYU Langone gastroenterologist takes a detailed medical history and conducts a physical exam. He or she also performs an upper endoscopy. If abnormal cells are found, your doctor may perform a biopsy at the same time as the endoscopy.
Upper Endoscopy with Biopsy
Doctors perform an upper endoscopy to identify any precancerous cells. During this procedure, the doctor examines the entire length of the esophagus, including the gastroesophageal junction, where the esophagus joins the stomach. After giving you a mild sedative to minimize discomfort, the gastroenterologist inserts an endoscope—a flexible tube with a camera at its tip—through the nose or mouth and into the esophagus.
If the lining of the esophagus looks abnormal, the doctor performs a biopsy to determine whether you have Barrett’s esophagus. He or she inserts small surgical tools through the endoscope to remove one or more tissue samples.
Specialists at NYU Langone may use a newer biopsy technique called wide area transepithelial sampling. In this approach, the doctor uses an abrasive brush to scrape cells from the esophageal lining. This technique provides pathologists with a larger sample of cells and may help doctors diagnose Barrett’s esophagus more quickly.
Tissue samples are sent to a laboratory, where a pathologist—a doctor who studies diseases with a microscope—examines them for the presence of abnormal cells.
If the biopsy results indicate that you have Barrett’s esophagus with little or no dysplasia, your doctor may choose to monitor you closely and prescribe a combination of medication and lifestyle changes to manage GERD. If the biopsy results indicate dysplasia, in which the cells are precancerous, your doctor may recommend more aggressive treatment with minimally invasive endoscopic procedures.
Endomicroscopy is an advanced endoscopic imaging technique that doctors at NYU Langone use to obtain real-time, microscopic images of esophageal tissue. This procedure is similar to an upper endoscopy, except your doctor inserts a tiny, powerful camera through the endoscope. The camera captures images of esophageal tissue and magnifies them to make individual cells visible on a computer screen in the doctor’s office.
Sometimes our specialists can identify precancerous cells in the esophagus using this technique. They may be able to diagnose Barrett’s esophagus without performing a biopsy.