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Barrett's Esophagus

Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) . GERD is a condition in which thestomach regurgitates its contents into the esophagus. This causes erosions in the esophagus. Barrett's esophagus occurs when the mucous lining of the esophagus heals abnormally. It is unclear why abnormal healing occurs, although the severity of the patient's reflux may be a factor.

A: Normal esophageal epithelium; B-D: Variants of Barrett's esophagus
A: Normal esophageal epithelium; B-D: Variants of Barrett's esophagus (click to enlarge)

Who Gets Barrett's Esophagus?

About 10 to 20 percent of patients with chronic GERD or inflammation of the esophagus will develop Barrett's esophagus. This condition is more common in men than in woman, and more common in Caucasian-Americans than in African-Americans. The average age at diagnosis is 55 years.

Barrett's Esophagus Symptoms

Barrett's esophagus produces symptoms similar to GERD or esophageal inflammation. See a gastroenterologist if you experience any of the following symptoms for more than two weeks:

  • Heartburn

  • Indigestion

  • Blood in vomit or stool

  • Difficulty swallowing solid foods

  • Nocturnal regurgitation (acidic or bitter liquid coming up to the chest or mouth during the night)

  • Barrett's Esophagus Diagnosis at Johns Hopkins

  • At Johns Hopkins, our experienced doctors use their expertise along with the most advanced imaging technologies to determine a careful and accurate diagnosis.

We are one of the few centers in the country using endoscopic confocal microscopy, in which a powerful microscope is used to help diagnose a condition during an endoscopy. The endomicroscope is a long tube with a camera on the tip that provides a detailed, high-resolution image that is used to identify abnormalities, allowing physicians to detect cancer cells without a biopsy. These “smart biopsies” precisely target the abnormal area, so invasive surgery is no longer necessary.

Barrett's Esophagus Diagnostic Procedures

A diagnosis of Barrett's esophagus begins with a comprehensive physical exam during which you describe your symptoms and medical history. Other diagnostic procedures include:

Barium Contrast Radiography

Barium contrast radiography is an X-ray study. It is one of the most common procedures to test for Barrett's esophagus.

During barium contrast radiography:

  1. You swallow a contrast solution called barium.

  2. The barium coats your esophagus and gastrointestinal tract, making it easier to detect abnormalities.

  3. An X-ray is taken.

  4. During the X-ray, your doctor looks for a narrowing in the esophagus called a stricture.

Upper Endoscopy

A gastroenterologist will most likely perform an upper endoscopy with biopsy to help diagnose Barrett's esophagus. During this procedure, the lining of the esophagus is checked for abnormalities. The endomicroscope is often used to analyze the tissue during an endoscopy, avoiding the need for a more invasive biopsy.

An upper endoscopy allows your doctor to examine the lining of your esophagus, stomach and the first part of your small intestine, called the duodenum. A gastrointestinal endoscopy examines the mucous lining of your upper gastrointestinal tract. The endoscopy and biopsy are two parts of the same procedure:

  • Endoscopy refers to the use of a flexible, lighted tube called an endoscope. The endoscope is inserted into your stomach through your mouth. There is a camera at the tip of the endoscope so your doctor can see the inside of your body.

  • Biopsy means a small tissue sample is removed and sent to a pathology lab for analysis.

    A: Short-segment and B: Long-segment Barrett’s esophagus; A’ and B’: Endoscopic views
    A: Short-segment and B: Long-segment Barrett’s esophagus; A’ and B’: Endoscopic views. (click to enlarge)

During an upper endoscopy:

  1. You receive an anesthetic to relax your gag reflex. You may also receive pain medication and a sedative.

  2. You lie on your left side, referred to as the left lateral position.

  3. Your doctor inserts the endoscope through your mouth and pharynx, into the esophagus.

  4. The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that helps your physician guide the endoscope through your esophagus.

  5. Your physician inserts biopsy forceps into the endoscope to obtain tissue samples.


A chromoendoscopy also may be used during an upper endoscopy procedure. A chromoendoscopy is a procedure that uses staining to identify abnormal areas that may be malignant (cancerous). During the endoscopy, we apply stains to the esophagus with a liquid called Lugol's solution. The dye stains only the normal cells; unstained areas may be malignant. The unstained areas are easily seen and tissue is removed from that area and sent for biopsy.

Barrett's Esophagus Treatment at Johns Hopkins

Barrett's esophagus is a complication of GERD, so your treatment may be similar. The goal is to heal the erosions of the esophageal lining and prevent the condition from spreading. We may use endoscopic surveillance to keep an eye on the progression of the disease. There is a risk of Barrett's esophagus becoming cancerous, so your condition may need to be monitored frequently. Learn more about Barrett's esophagus treatment at Johns Hopkins.

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