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UCLA Division of Digestive Diseases


Diseases and Conditions - More Information


What is Barrett's esophagus?
Barrett's esophagus is a pre-cancerous condition affecting the lining of the esophagus.

How does Barrett's esophagus develop?
Gastroesophageal reflux disease (GERD) is a disorder in which stomach contents move up into the esophagus, producing symptoms such as heartburn, regurgitation and chest pain. In some patients with GERD, the normal esophageal lining is damaged and takes on  on a different appearance both endoscopically and microscopically.  This is called "intestinal metaplasia" or Barrett's esophagus. Patients with GERD symptoms more than twice a week should consult with their physician.

How is Barrett's esophagus diagnosed?
A diagnosis of Barrett's esophagus requires that the patient undergoes an upper endoscopy procedure by their physician. Endoscopy is a non-surgical procedure and is performed using moderate sedation. Barrett's esophagus tissue appears as a different color on examination, which directs a biopsy of the tissue for pathology evaluation. A finding of intestinal cells in the esophagus (intestinal metaplasia) confirms a Barrett's esophagus diagnosis.

How is Barrett's treated?
Joint recommendations from medical societies recommend that a patient with Barrett's esophagus should undergo an upper endoscopy procedure with biopsies on a regular basis for the remainder of their lifetime. In addition to surveillance endoscopy approaches for Barrett's esophagus, there are treatment options that include endoscopic and surgical therapy to eliminate the Barrett's tissue completely. Endoscopic procedures include:

Endoscopic Mucosal Resection (EMR)
EMR encompasses the removal of precancerous and early gastrointestinal tumors using minimally invasive endoscopic techniques. EMR is currently used to remove tumors of the esophagus, stomach and colon/rectum, along with Barrett's esophagus and colon polyps. EMR can be used to avoid surgical treatment of these lesions.

Radiofrequency Ablation (RFA)
RFA is a thermal ablative technique that utilizes current that is delivered through a balloon catheter or probe to treat Barrett's esophagus and early esophageal cancer. RFA is a safe, minimally invasive treatment that may prevent the need for esophageal surgery. This procedure can be performed as a come-and-go procedure.

Cryotherapy uses extreme cold to ablate diseased tissue in the GI tract. Liquid nitrogen or carbon dioxide is delivered using a catheter passed through an endoscope to freeze the target tissue. Cryotherapy has been used in the treatment of Barrett's esophagus and esophageal cancer.


What is Eosinophilic esophagitis (EoE)?
EoE is a common cause of difficulty swallowing, or dysphagia, in adults. It is thought to be an allergic condition, related to food or other environmental allergens, which causes inflammation and scarring that can affect both esophageal structure and function. In some way, it can be thought of as an asthma-like condition in the esophagus. Typical symptoms include an intermittent sensation of food sticking inside the chest, chest pain or heartburn. In severe cases, food can get stuck in the esophagus requiring an endoscopy to remove the trapped food.

How is EoE diagnosed?
Diagnosing EoE requires that a patient undergo an upper endoscopy to look at the lining of the esophagus and to take biopsies looking for eosinophils. 

How is EoE treated?
Several potential treatment options exist, including proton pump inhibitors (PPIs) and topical steroids.  Specific food elimination diets may also be used to identify the causative food(s), avoidance of which can improve inflammation and symptoms. Additionally, if a narrowing is seen in the esophagus, the endoscopist can dilate this area to provide more-immediate relief of symptoms.


What is esophageal cancer?
Esophageal cancer is a cancerous (malignant) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

Esophageal cancer is when malignant (cancer) cells grow in the esophagus. There are two common forms of esophageal cancer and they are named for the cells that become malignant (cancerous).

  • Squamous Cell Carcinoma: This is cancer that forms in the squamous cells. These cells are thin and flat; found in tissues that form the surface of the skin, hollow organs of the body and the passages of the respiratory and digestive tracts. SCC is generally found in the upper and middle portions of the esophagus but can occur anywhere. It arises in mutations of the traditional lining cells of the esophagus.
  • Adenocarcinoma: This is cancer that forms in the glandular cells. Glandular cells produce and release fluids such as mucous. Adenocarcinoma is generally found in the lower portion of the esophagus near the stomach, and most commonly arises from mutations resulting from chronic acid reflux disease, i.e. Barrett's esophagus.

How is esophageal cancer diagnosed and treated?
Your treatment options will depend on the type of cancer, the stage of your cancer and your overall health.
Staging of esophageal cancer, using endoscopic ultrasound (EUS), is extremely important since it helps differentiate treatment options. EUS combines traditional endoscopy with ultrasound imaging to visualize structures within the wall of the GI tract and beyond. A miniature ultrasound transducer is housed at the tip of an endoscope, allowing for visualization of a broad range of structures from the esophagus to rectum. From within the esophagus, the mediastinum and associated lymph nodes can be seen, and diseased nodes can be sampled using fine-needle aspiration (FNA).

Staging results can help identify treatment modalities for esophageal cancer, including:

  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Combinations of the above options

Other treatments that may be used to help the patient swallow include endoscopic dilation of the esophagus (sometimes with placement of a stent to keep the esophagus dilated).

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