Designed and created by Guideline Central in participation with the American College of Gastroenterology
Diagnosis and Management of Barrett’s Esophagus
Patient Guideline Summary
Publication Date: March 29, 2022
Last Updated: March 3, 2023
Objective
Objective
This patient summary means to summarize key recommendations from the American College of Gastroenterology (ACG) for diagnosis and management of Barrett’s Esophagus. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.
Overview
Overview
- Barrett’s esophagus is damage to the distal esophagus (that part just above the stomach). The normal flat epithelium (surface layer of cells) is replaced by specialized columnar (tall or cylindrical) epithelium with cells called goblet cells. This damage is caused by chronic gastroesophageal reflux disease (GERD) (stomach acid flowing upward, causing heartburn or indigestion).
- We will use the abbreviation BE throughout this summary to refer to Barrett’s esophagus.
- BE is the only known lesion which can become the cancer called esophageal adenocarcinoma (EAC).
- This patient summary focuses on the diagnosis, screening, surveillance, and endoscopic and medical therapy of BE.
Diagnosis of BE
Diagnosis of BE
- The diagnosis of BE requires the finding of intestinal metaplasia (IM) in the esophagus. (“Metaplasia” is a change in the microscopic appearance of cells from normal to abnormal, in this case from flat cells to goblet cells).
- ACG suggests at least 8 endoscopic biopsies in screening examinations when endoscopic findings are consistent with possible BE. One reason is that goblet cells are so few they can be missed, giving a false negative test result.
- ACG recommends that any dysplasia (presence of abnormal cells due to metaplasia) detected on biopsies of BE be confirmed by a second pathologist with experience in gastrointestinal (GI) pathology.
- Your doctor may order a single screening endoscopy if you have chronic GERD symptoms and 3 or more additional risk factors for BE including:
- male sex
- age >50 years
- White race
- tobacco smoking
- obesity
- family history of BE or EAC in a first-degree relative
- Your doctor may ask you to swallow a small sponge-like device on a string. This gadget samples the cells for examination.
- This can be performed in an office by trained non–physician providers and does not require the use of sedation.
- ACG does not suggest repeating endoscopic screening if you have undergone an initial negative screening examination by endoscopy.
- ACG recommends both white light endoscopy and chromoendoscopy if you are undergoing endoscopic surveillance of BE. (Sometimes different colored lights show better detail).
- The goal of endoscopic surveillance is the detection of abnormal cells or cancer at an early stage.
- Endoscopic surveillance may be performed at intervals dictated by the degree of dysplasia noted on previous biopsies.
- ACG recommends that the length of the nondysplastic BE (NDBE [non-cancer cells]) segment be considered when assigning surveillance intervals (3 or 5 years).
Treatment of BE
Treatment of BE
Non-endoscopic treatment of BE:
Your doctor may prescribe a proton pump inhibitor (PPI) medication once or twice a day if you have BE without allergy or other reason not to use a PPI.
Your doctor may prescribe a proton pump inhibitor (PPI) medication once or twice a day if you have BE without allergy or other reason not to use a PPI.
- ACG does not suggest the use of anti-reflux surgery to prevent cancer developing in patients with BE.
Endoscopic treatment of BE
Endoscopic treatment of BE
- Your doctor may choose endoscopic therapy if you have BE with confirmed low-grade dysplasia (LGD) to reduce the risk of progression to high-grade dysplasia (HGD)/EAC.
- If you have BE with HGD or intra-mucosal cancer (IMC) your doctor may recommend endoscopic eradication therapy (EET), a more extensive procedure usually performed at centers that have extensive experience.
- ACG recommends an endoscopic surveillance program in patients with BE who have completed successful EET.
Abbreviations
- ACG: American College Of Gastroenterology
- BE: Barrett’s Esophagus
- EAC: Esophageal Adenocarcinoma
- EET: Endoscopic Eradication Therapy
- GERD: Gastro-esophageal Reflux Disease
- GI: Gastrointestinal
- HGD: High-grade Dysplasia
- IM: Intestinal Metaplasia
- IMC: Intra-mucosal Cancer
- LGD: Low-grade Dysplasia
- NDBE: Nondysplastic BE
- PPI: Proton Pump Inhibitor
Source Citation
Shaheen NJ, Falk GW, Iyer PG, Souza RF, Yadlapati RH, Sauer BG, Wani S. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline. Am J Gastroenterol. 2022 Apr 1;117(4):559-587. doi: 10.14309/ajg.0000000000001680. PMID: 35354777.
Disclaimer
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.