Barrett’s esophagus does not cause symptoms itself and is important only because it seems to precede the development of a particular kind of cancer – esophageal adenocarcinoma.

The risk of developing adenocarcinoma is 30 to 125 times higher in people who have Barrett’s esophagus than in people who do not. This type of cancer is increasing rapidly in white men. The increase is possibly related to the rise in obesity and gastroesophageal reflux disease (GERD).

For people who have Barrett’s esophagus, the risk of getting cancer of the esophagus is small: less than 1 percent (0.4 percent to 0.5 percent) per year.

Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective.

Surveillance for Dysplasia and Cancer

Periodic endoscopic examinations to look for early warning signs of cancer are generally recommended for people who have Barrett’s esophagus. This approach is called surveillance.

When people who have Barrett’s esophagus develop cancer, the process seems to go through an intermediate stage in which cancer cells appear in the Barrett’s tissue. This condition is called dysplasia and can be seen only in biopsies with a microscope. The process is patchy and cannot be seen directly through the endoscope, so multiple biopsies must be taken. Even then, it can be missed.

The process of change from Barrett’s to cancer seems to happen only in a few people, less than 1 percent per year, and over a relatively long period of time. Most physicians recommend that people with Barrett’s esophagus undergo periodic surveillance endoscopy to have biopsies. The recommended interval between endoscopies varies depending on specific circumstances, and the ideal interval has not been determined.

Source: digestive.niddk.nih.gov – July 2008