GERD occurs when the sphincter muscle, which keeps stuff in your stomach, doesn’t do its job, allowing food and digestive juices, including acids, to travel back up the esophagus. Left untreated, though, the acidic juices can, over time, damage the lining of the esophagus, causing abnormal cells, a condition called Barrett’s esophagus. Common in men and in middle-aged and older people, Barrett’s esophagus increases the risk of developing esophageal cancer 30- to 125-fold.
The only way to know if you have Barrett’s esophagus is to have an endoscopy. During the procedure, the gastroenterologist runs a thin, flexible tube called an endoscope down your esophagus to your stomach to examine the esophageal lining. “In someone with Barrett’s, the lining looks more like the deep-red lining of the stomach compared to its normal pink,” explains Dr. Bruce D. Greenwald, chairman of the board of the Esophageal Cancer Action Network.
Since it’s not clear who needs to be checked for Barrett’s, Greenwald, also a professor of medicine in the division of gastroenterology and hepatology at the University of Maryland School of Medicine in Baltimore, recommends talking with your doctor. Candidates include anyone with severe heartburn or people who are overweight or obese.
If Barrett’s esophagus is diagnosed, your doctor will perform a biopsy to see if you have dysplasia—which means abnormal cells have changed and could progress to cancer. If no dysplasia is found, the American Society for Gastrointestinal Endoscopy recommends getting a second endoscopy the following year. If there’s still no sign of dysplasia, the next endoscopy can be done in three to five years. If dysplasia is detected, guidelines advise having an endoscopy every three months. If after two consecutive endoscopies, there’s no sign of dysplasia (it can disappear), the time between follow-up procedures can be lengthened.
If the doctor sees raised tissue—indicating something suspicious— abnormal tissue is suctioned out during a procedure called resection. If more advanced dysplasia is spotted, all abnormal tissue is burned, or cauterized during a procedure called radiofrequency ablation. Tissue can also be frozen with liquid nitrogen, in a process known as cryotherapy.