Barrett's Esophagus

Barrett's esophagus occurs when the normal lining of the esophagus (the tube that connects the mouth to the stomach) is replaced with tissue similar to that found in the intestinal lining. It can result from chronic esophageal inflammation (esophagitis), such as that caused by gastroesophageal reflux disease (GERD). Because Barrett's esophagus can increase the risk of esophageal cancer later in life, it's important that children with esophagitis receive routine evaluation and screening for the condition.

Barrett's esophagus doesn't cause any symptoms itself. However, people with Barrett's esophagus often also have GERD, which can have symptoms such as heartburn, belching, coughing, choking, and wheezing. GERD may also not have any symptoms.

Although the exact cause of Barrett's esophagus isn't clear, it seems to be related to chronic esophageal inflammation, or esophagitis. The acid or bile reflux associated with GERD can lead to chronic inflammation. GERD can be found in conditions such as esophageal atresia, ingestion of corrosive substances (such as certain household cleaners), eosinophilic esophagitis, and infection.

Over time, this inflammation appears to damage the cells in the lining of the esophagus. Instead of healing, these cells grow to resemble the cells that line the intestines. Barrett's esophagus has been linked to an increased risk of esophageal cancer.

Clinicians typically use an endoscopy to diagnose Barrett's esophagus. In this test, a thin, flexible lighted tube with a tiny camera at the end is passed through your child's throat into the esophagus to look for signs of diseased tissue. The physician will likely also remove small bits of tissue (biopsy) from the esophagus to test for the presence of Barrett's esophagus and the extent of the change.

Based on these findings, the clinician will determine the degree of tissue change, rating it from no dysplasia (the presence of Barrett's esophagus without precancerous changes) to high-grade dysplasia (the final stage before Barrett's esophagus becomes esophageal cancer).

The goal of treatment for Barrett's esophagus is to monitor tissue changes through regular endoscopies. Your child should also receive treatment for the root cause of inflammation, such as taking acid-blocking medication to address GERD.

Higher degrees of esophageal tissue change from Barrett's esophagus usually don't occur until adulthood. Depending on the degree of dysplasia, physicians may treat it with techniques such as:

• Endoscopic resection (using an endoscope to remove damaged cells)
• Radiofrequency ablation (using heat to remove abnormal tissue)
• Cryotherapy (using extreme cold to remove abnormal tissue)
• Surgery to remove the diseased portion of the esophagus

Even with treatment, Barrett's esophagus can recur, especially if the original source of chronic inflammation isn't addressed.

The clinicians at Boston Children's Hospital take a proactive approach to Barrett's esophagus. Outcomes from Boston Children's suggest that a good percentage of esophageal atresia patients have biopsy-proven esophagitis, even if they don't have any symptoms. For this reason, we recommend that every child who has been treated for esophageal atresia be routinely screened for esophagitis through endoscopy.