May 23, 2025 When Acid Reflux Turns Dangerous

Screening for Barrett’s esophagus can help stop an on-the-rise cancer before it develops.

The best cancer-related care is the kind that prevents the disease from occurring in the first place. Millions of people act on that idea when they get colonoscopies to find and remove polyps that can lead to colorectal cancer.

But there’s another type of potentially precancerous condition that’s less well known and often overlooked. Called Barrett’s esophagus, it’s a major risk factor for esophageal cancer, which—like colorectal cancer—is a gastrointestinal cancer that’s on the rise.

As with colorectal cancer, learning early on that you have Barrett’s esophagus—a condition that occurs in the tube-like structure connecting the mouth to the stomach—can lead to treatment that prevents cancer from developing.

“The problem with Barrett’s is that many people don’t know they have it until it turns to cancer,” says Arvind Trindade, MD, Vice President of Gastrointestinal Clinical Operations at RWJBarnabas Health (RWJBH); Co-Chief of Endoscopy at Robert Wood Johnson University Hospital (RWJUH); Director of the RWJUH Barrett’s Esophagus Program; and a member of RWJBarnabas Health Medical Group. “It’s often a silent condition.”

In many cases, patients who go on to develop esophageal cancer become aware of it only when it starts to make swallowing difficult. “Unfortunately, that’s usually in later stages when patients don’t have the best prognosis,” Dr. Trindade says. “It’s important to screen for Barrett’s esophagus in certain people, especially those who are at high risk.”

Screening Realities

Barrett’s esophagus occurs when chronic regurgitation sends stomach acid into the esophagus—a condition known as GERD, or gastroesophageal reflux disease. “Stomach acid injures the esophagus, which transforms itself to protect against acid reflux damage,” Dr. Trindade says. This can lead to cell abnormalities broadly known as dysplasia, which in turn can set the stage for cancer.

Most people with Barrett’s esophagus won’t get cancer. But some do, with risks depending partly on how much any dysplasia has changed.

Caucasian males over age 50 are among those at highest risk of developing Barrett’s esophagus. Risks are higher for men experiencing obesity, which boosts the chances of having GERD. “Having a first-degree relative such as a parent or sibling with Barrett’s is probably the strongest risk factor,” Dr. Trindade says. “If a family member had the condition, you should be screened.”

Don’t assume you’re not at risk if you don’t have GERD symptoms such as noticeable regurgitation or a sour taste at the back of your mouth; pain or burning in your chest, especially after eating; or difficulty sleeping.

“About 40 percent of people who have GERD don’t have GERD symptoms,” Dr. Trindade says. “You can’t say, ‘I don’t have reflux, so I don’t have to worry.’ If you’re overweight and older, it’s important to get screened.”

Yet research by Dr. Trindade and others indicates that many people miss this crucial step. “In one study, we looked at records of close to a million primary care patients and found that seven of 10 people who met criteria for being at risk were not screened,” Dr. Trindade says.

One long-standing screening option is endoscopy, in which a tube equipped with a high-definition camera is threaded down the throat to look for Barrett’s-related dysplasia. “Ideally, endoscopic screening is done at a Barrett’s esophagus center with specialists who have a trained eye for detecting concerning patterns, which can be very subtle,” Dr. Trindade says.

Advanced Methods

More recently, advanced non-endoscopic alternatives have emerged. Patients often progress through these testing and treatment options:

• In one screening method, the patient swallows a tethered capsule containing a textured balloon that expands in the esophagus and captures cells for analysis. Once deflated, the balloon is removed through the mouth. The screening can be done in a doctor’s office in about 10 minutes. “At our specialized Barrett’s Esophagus Program, we’ll often begin with a non-endoscopic screening and follow up on any positive results with an endoscopy to learn more,” Dr. Trindade says.
• The RWJUH program offers an advanced form of endoscopy called WATS 3D (wide-area transepithelial sampling with 3D analysis), which uses a brush to sample a larger area than with standard endoscopy. Samples are reviewed under a microscope using a computer equipped with artificial intelligence (AI) that reliably detects precancerous cells. Tissue flagged by AI is then examined by a human pathologist. “We helped pioneer this technology, and not a lot of places have it,” Dr. Trindade says.
• If samples come up negative, patients generally follow up with another screening in three years.
• Treatment options include endoscopic removal of concerning tissue; radiofrequency ablation, in which a heated probe destroys dysplasia; cryotherapy, which uses cold to reach abnormal tissue in deeper areas; and a hybrid technology that can help when other methods aren’t effective enough.
• At-risk patients and those who’ve had a procedure can benefit from lifestyle measures to reduce GERD, such as not smoking, losing weight and avoiding foods that can trigger reflux, such as spicy fare, tomato sauce, chocolate, citrus and carbonated drinks.

“To have an advanced Barrett’s Esophagus Program that not only offers cutting-edge screening and treatment options but also conducts groundbreaking research is highly unusual,” Dr. Trindade says. “Only a handful of centers like ours exist nationwide. We’re really trying to make a dent in the incidence of esophageal cancer. It can be life-changing for patients who are cured of it without ever experiencing symptoms.”

Learn more about digestive care at RWJBarnabas Health.