Barrett’s Esophagus

A gastroenterologist, a specialist in gastrointestinal diseases, usually diagnoses Barrett’s esophagus. They’ll look inside your esophagus for evidence of the tissue changes and take small tissue samples to confirm them (biopsies). They’ll do this in a procedure called an endoscopy. This means putting a tiny camera on a long tube down your throat to examine your esophagus, while you’re under sedation.

What are the signs of Barrett’s esophagus on examination?

In general, normal esophageal lining is pale pink and smooth, while intestinal metaplasia is salmon-colored and coarse. But inflammation in your esophagus could obscure these features. Your provider might need to take multiple biopsy samples from different places to study under a microscope. This is how they’ll confirm the structural changes in the cells of your esophagus lining (epithelium).

Normal esophageal epithelium consists of stratified squamous cells. These are flat, square cells arranged in layers (“squamous” means flat, and “stratified” means in layers). The lower part of your GI tract (your intestine) is lined with columnar epithelium. Columnar cells are rectangular and lay side-by-side in a single layer. If these appear in your esophagus, your provider will diagnose Barrett’s esophagus.

Classifying Barrett’s esophagus

Your provider might describe your condition as:

• Short-segment Barrett’s esophagus. This means the affected area is less than 3 cm long.
• Long-segment Barrett’s esophagus. This means the affected tissue is longer than 3 cm.

They might define the stage as:

• Non-dysplastic metaplasia. This means there’s no dysplasia yet and a low cancer risk.
• Metaplasia with low-grade dysplasia. This means there’s some dysplasia and cancer risk.
• Metaplasia with high-grade dysplasia. This means there’s significant dysplasia and cancer risk.
• Carcinoma. This means dysplasia has progressed to cancer.

Other findings

People with Barrett’s esophagus may also have:

• Esophageal stricture. This means your esophagus has become narrower, often due to scarring.
• Peptic ulcers. These are open sores caused by stomach acid or enzymes.