Barrett esophagus

by Jason Wasserman MD PhD FRCPC
July 25, 2025

Barrett esophagus is a condition where the normal lining of your esophagus is gradually replaced by a different type of cell. The esophagus is the tube that carries food and liquids from your mouth to your stomach. It is normally lined by squamous cells, which are flat, strong cells built to handle the wear and tear of swallowing.

In Barrett esophagus, these squamous cells are replaced by glandular cells that are not normally found in the esophagus. Instead, these cells are typically found in the stomach or intestines. This change is called intestinal metaplasia, and it increases the risk of developing esophageal adenocarcinoma, a type of cancer.

Barrett esophagus is considered a precancerous condition, but not everyone with Barrett’s will develop cancer. However, regular monitoring is important so any further changes can be caught and treated early.

What causes Barret esophagus?

Barrett esophagus is most often caused by long-term damage from gastroesophageal reflux disease (GERD). GERD occurs when stomach acid flows backward into the esophagus on a regular basis, causing irritation. Over time, this acid damage may lead to inflammation and changes in the esophageal lining.

Although GERD is the strongest known risk factor, not everyone with GERD will develop Barrett esophagus.

Other factors that may increase the risk include:

  • Long-standing GERD (especially over 10 years).

  • Being male.

  • Age over 50.

  • Obesity (especially central or abdominal obesity).

  • Smoking.

  • Family history of Barrett esophagus or esophageal cancer.

What are the symptoms of Barrett esophagus?

Barrett esophagus itself often causes no noticeable symptoms. Most people who are diagnosed with Barrett esophagus are being evaluated for GERD.

Common symptoms of GERD include:

  • Frequent heartburn.

  • Difficulty swallowing (also called dysphagia).

  • Regurgitation of sour-tasting fluid or food.

  • A sensation of food getting stuck in the chest or throat.

Because Barrett’s does not always cause specific symptoms, it is often diagnosed during an evaluation for chronic reflux symptoms.

How is Barrett esophagus diagnosed?

The diagnosis of Barrett esophagus is made during a procedure called an upper endoscopy. During this test, a doctor uses a thin, flexible tube with a camera on the end (called an endoscope) to look at the lining of your esophagus.

If the doctor sees areas that look abnormal—usually reddish patches where the normal pale pink squamous cells are replaced—they will take small tissue samples called biopsies from these areas. These samples are sent to a pathologist, who examines them under a microscope to look for intestinal metaplasia, the key microscopic feature of Barrett esophagus.

What does Barrett esophagus look like under the microscope?

Under the microscope, a pathologist looks for glandular cells and goblet cells in the tissue. Goblet cells are special mucus-producing cells normally found in the intestines. They are larger than typical cells and contain a blue or purple substance called mucin.

The presence of goblet cells confirms intestinal metaplasia, which is required for the diagnosis of Barrett esophagus.

What is dysplasia in Barrett esophagus?

Dysplasia means that the cells in the Barrett tissue have started to look abnormal under the microscope. Dysplasia is important because it is a precancerous change—it means the cells are beginning to take on features that could eventually lead to cancer if not treated or monitored.

Pathologists classify dysplasia in Barrett esophagus into two main categories.

Barrett esophagus with low grade dysplasia

In this condition, the cells show mild to moderate abnormalities. While the risk of developing cancer is higher than in Barrett’s without dysplasia, it is still considered relatively low. Your doctor may recommend:

  • More frequent endoscopies to monitor for further changes.

  • Endoscopic treatment in some cases, such as radiofrequency ablation or endoscopic mucosal resection.

The decision depends on your individual risk factors and the severity of the dysplasia.

Barrett esophagus with high grade dysplasia

High grade dysplasia is more serious. The cells appear much more abnormal and disorganized, and there is a greater chance that they could turn into cancer. Because of this higher risk, treatment is usually recommended and may include:

  • Endoscopic therapy to remove or destroy the abnormal tissue.

  • Surgery to remove part or all of the esophagus (in some cases).

After treatment, regular follow-up with endoscopy and biopsy is important to monitor for recurrence or progression.

Why is Barrett esophagus important?

Barrett esophagus itself is not cancer, and most people with the condition will never develop cancer. However, it is a warning sign that the esophagus has undergone significant changes due to chronic acid damage. By identifying and monitoring Barrett esophagus, doctors can find dysplasia early and treat it before cancer develops.

If you’ve been diagnosed with Barrett esophagus, it’s important to:

  • Follow your doctor’s recommendations for endoscopy and surveillance.

  • Take steps to control GERD (such as using acid-suppressing medications or lifestyle changes).

  • Discuss any family history of Barrett’s or esophageal cancer with your healthcare team.

Questions to ask your doctor

  • Was any dysplasia (abnormal or precancerous cells) seen in my biopsy?

  • How often should I have follow-up endoscopies or biopsies?

  • Are there treatments available to remove or treat the abnormal cells?

  • What are my options to manage acid reflux and reduce further damage?

  • How can changes to my diet or lifestyle help with my condition?

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