Barrett’s Esophagus Treatment Options

Not everyone with GERD will develop Barrett’s, but the risk is higher for people with chronic reflux. Other factors that raise risk include:

• Being male
• Age over 50
• White ethnicity
• Obesity, especially with extra fat around the waist
• Smoking
• Family history of Barrett’s esophagus or esophageal cancer

The condition is usually found during an upper endoscopy. In this procedure, a thin tube with a light and camera is passed through the mouth into the esophagus. The doctor looks at the lining and may take small tissue samples for biopsy. These samples are examined under a microscope to confirm whether Barrett’s esophagus is present and whether dysplasia is developing.

Treatment has two main goals: controlling acid reflux to prevent further damage and reducing the risk of progression to cancer. The right treatment depends on whether dysplasia is present and, if so, its severity.

Medications

The most common treatment is the use of proton pump inhibitors (PPIs). These drugs reduce stomach acid production, which helps heal irritation and prevents further injury. PPIs do not reverse Barrett’s changes, but they lower acid exposure and make it less likely that new damage will occur. Some patients require higher doses to fully control symptoms and acid levels.

Lifestyle changes

We often recommend lifestyle adjustments to manage reflux and protect the esophagus. These include maintaining a healthy weight, avoiding foods that trigger heartburn (such as coffee, alcohol, chocolate, and spicy foods), eating smaller meals, avoiding late-night eating, and quitting smoking. Elevating the head of the bed can also help prevent acid from flowing back up while sleeping.

Endoscopic therapies

If dysplasia is found, or if the risk of cancer is high, endoscopic treatments are available. These procedures are done through an endoscope without the need for major surgery. Options include:

• Radiofrequency ablation (RFA): RFA uses controlled heat energy to destroy abnormal tissue so normal tissue can grow back. It is highly effective, especially for low- and high-grade dysplasia.
• Endoscopic mucosal resection (EMR): Removes abnormal or raised areas of the esophagus lining. This is often used when small patches of dysplasia are present.
• Cryotherapy: Uses extreme cold to freeze and destroy abnormal cells. This can be helpful when ablation is not successful or appropriate.

These treatments are safe and effective for most patients, with a strong record of reducing the risk of cancer.

Surgery

In rare cases, when there is extensive high-grade dysplasia or early cancer that cannot be managed endoscopically, surgery may be required. This involves removing part or all of the esophagus (esophagectomy). Surgery is a major operation but is less common today thanks to the success of endoscopic treatments.

Treatment for Barrett’s esophagus has become highly effective. Acid-suppressing medications control symptoms and prevent further damage for most patients. Endoscopic therapies such as radiofrequency ablation have success rates above 90% in eliminating dysplasia and reducing the risk of cancer. With careful monitoring and the right interventions, the likelihood of cancer developing can be reduced dramatically.

Even after treatment, people with Barrett’s esophagus require regular follow-up endoscopies. The frequency depends on whether dysplasia is present:

• No dysplasia: Every 3–5 years
• Low-grade dysplasia: Every 6–12 months, or after ablation to ensure healthy tissue regrows
• High-grade dysplasia: Immediate treatment followed by close monitoring

This ongoing care allows doctors to detect changes early, when they are easiest to treat.

Most people with Barrett’s esophagus never develop cancer, especially when the condition is monitored and treated as needed. With today’s medical therapies, lifestyle changes, and advanced endoscopic options, the risk of progression is much lower than it once was. The key is early detection, ongoing monitoring, and following treatment plans closely.