The American College of Gastroenterology advises that individuals with chronic or frequent reflux symptoms (usually heartburn) and other risk factors undergo upper endoscopy to determine if Barrett's esophagus is present and to assess for premalignant features.

Along with chronic reflux symptoms, risk factors for developing Barrett's esophagus include male gender, advancing age (>50 years), Caucasian race, smoking, central obesity, and family history of Barrett's esophagus or esophageal cancer. [1] These factors are taken into account when deciding if a patient should undergo upper endoscopy for Barrett's screening.

Upper endoscopy is a simple, painless, low risk outpatient procedure requiring less than an hour. This is accomplished by insertion of a slim, flexible tube with a camera at its tip (endoscope) through the mouth into the esophagus. A computer and TV screen provide an image of the esophagus that allows the gastroenterologist to assess for inflammation (esophagitis) and Barrett's esophagus. The diagnosis of Barrett's esophagus is made by biopsy, or sampling of the esophageal lining.

At Johns Hopkins, biopsies are sent to the Division of Gastrointestinal Pathology, where microscope slides are prepared from the biopsy tissue. Gastrointestinal pathologists use microscopy to examine the slides and provide a diagnosis.

Reference:

1. Shaheen NJ, Falk GW, Iyer PG, Gerson LB; American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016 Jan;111(1):30-50.