Barrett oesophagus

Overview

Barrett’s oesophagus is a condition where the lining of the lower part of the food pipe (the oesophagus) changes to look more like the lining of the stomach. This change happens over time, often because of long-term acid reflux (when stomach acid flows back up into the food pipe). It is not cancer, but it can raise the risk of developing a type of oesophageal cancer. Most people with Barrett’s oesophagus do not get cancer, and regular checks can help catch any changes early.

Barrett’s oesophagus is not very common, but it is seen more often in people with long-term acid reflux. It affects about 1 to 2 in every 100 people in the UK.

It mostly affects adults over 50, men more than women, and people who have had chronic acid reflux for many years. It is also more common in people who are overweight, smoke, or have a family history of Barrett’s or oesophageal cancer.

Symptoms

Common symptoms

• Barrett’s oesophagus itself often does not cause symptoms. Most symptoms come from the acid reflux that caused it.
• Frequent heartburn – a burning sensation in the chest or throat.
• Regurgitation – food or sour liquid coming back up into the mouth.
• Trouble swallowing (dysphagia) – feeling like food gets stuck in the chest.
• A persistent cough, hoarseness, or sore throat.

Symptoms in children

• Barrett’s oesophagus is very rare in children. Symptoms would be similar to those in adults, such as ongoing heartburn, vomiting, or trouble eating.

Symptoms in older adults

• Older adults may have the same symptoms, but sometimes they have less noticeable heartburn. Instead, they might have issues like anaemia (low red blood cells) or unexplained weight loss.

Causes

Main causes

• Long-term acid reflux (GORD/GERD) damages the lining of the lower oesophagus. Over time, the body replaces the damaged cells with new cells that are more like those in the stomach or intestines.

Risk factors

• Having chronic acid reflux for many years.
• Being over 50 years old.
• Being male.
• Having a large hiatal hernia (a condition where part of the stomach pushes up through the diaphragm).
• Being overweight or obese.
• Smoking tobacco.
• Having a family history of Barrett’s oesophagus or oesophageal cancer.

When to see a doctor

See a doctor urgently if:

• Trouble swallowing that is getting worse.
• Unexplained weight loss.
• Vomiting blood or passing black stools.

Book a routine appointment if:

• If you have frequent heartburn or reflux symptoms that do not improve with over-the-counter remedies.
• If you have been told you have Barrett’s oesophagus and need regular follow-up endoscopies.

Diagnosis

Barrett’s oesophagus is usually diagnosed with an upper endoscopy. This is a test where a doctor uses a thin, flexible tube with a camera to look inside your oesophagus and take small samples of tissue (biopsies) to check for cell changes.

Tests that may be done

• Upper endoscopy (gastroscopy) – the main test.
• Biopsy – small tissue samples are taken during endoscopy and examined under a microscope.
• Sometimes a special test called pH monitoring is used to measure acid levels in your oesophagus if reflux is unclear.

What to expect at your appointment

Before the endoscopy, you will be given a sedative to help you relax and a spray to numb your throat. You will lie on your side while the doctor passes the tube through your mouth and down your oesophagus. The test usually takes about 15 to 30 minutes. You may have a sore throat afterward but can go home the same day. Your doctor will discuss the results and when you need your next check-up.

Treatment

Treatment for Barrett’s oesophagus focuses on controlling acid reflux and monitoring the oesophagus for any precancerous changes. If high-risk changes (dysplasia) are found, treatment may involve removing or destroying the abnormal cells.

Self-care at home

• Maintain a healthy weight – excess weight can worsen reflux.
• Avoid large meals late at night. Eat smaller, more frequent meals.
• Do not lie down for at least 2 to 3 hours after eating.
• Elevate the head of your bed by about 15–20 cm (use extra pillows or a foam wedge).
• Avoid foods and drinks that trigger your reflux, such as spicy foods, citrus, tomatoes, chocolate, caffeine, alcohol, and fried foods.
• Quit smoking – smoking weakens the lower oesophageal sphincter and increases acid reflux.

Medical treatments

Doctors usually prescribe acid-reducing medicines to control reflux. These include medicines called proton pump inhibitors (PPIs) and H2 blockers. They help reduce stomach acid and allow the oesophagus to heal. Always take these as directed by your doctor. Do not stop or change your dose without talking to your healthcare team. For high-risk changes (dysplasia), treatments include endoscopic resection (removing abnormal tissue during endoscopy) or ablation (using heat or radiofrequency to destroy abnormal cells).

When is surgery considered?

Surgery for Barrett’s oesophagus is rarely needed. It may be considered if there is severe dysplasia (very abnormal cells) that cannot be treated with endoscopy, or if early cancer develops. The most common surgery is called oesophagectomy (removing part of the oesophagus). Your doctor will discuss options if this is relevant for you.

Living with this condition

Living with Barrett’s oesophagus means taking steps to manage your acid reflux and keeping up with regular check-ups. Most people can lead a normal life. It is important to take your medicines as prescribed and follow lifestyle advice.

Lifestyle tips

• Take your acid-reducing medicines consistently, even if you feel well.
• Keep all your follow-up endoscopy appointments – they are vital for detecting any changes early.
• Learn to recognise reflux triggers and avoid them.
• Do not smoke, and limit alcohol.
• Exercise regularly – moderate activity can help with weight control and digestion.

Diet and exercise

A balanced diet that is low in fatty, acidic, and spicy foods can help reduce reflux. Include plenty of vegetables, lean proteins, and whole grains. Avoid eating late at night. Gentle exercise, like walking or swimming, is good for overall health. Avoid heavy lifting or exercises that put pressure on your stomach right after meals.

Mental health and emotional wellbeing

Being diagnosed with a condition that can increase cancer risk can cause anxiety or worry. It is normal to feel concerned, but remember that most people with Barrett’s oesophagus never develop cancer. Talk to your doctor if you feel anxious; they can provide reassurance and connect you to support services. Mindfulness, relaxation techniques, and support groups can also help.

Prevention

Barrett’s oesophagus cannot always be prevented, but you can lower your risk by managing acid reflux early, maintaining a healthy weight, quitting smoking, and avoiding foods that trigger reflux.

Screening programmes

Routine screening for Barrett’s oesophagus is not recommended for everyone. However, if you have long-term acid reflux and other risk factors (such as being over 50, male, or having a family history), talk to your doctor about whether an endoscopy might be right for you.

Complications

If left untreated

• Progression to dysplasia (abnormal cells) or early oesophageal cancer (adenocarcinoma) – this is rare but is why monitoring is important.
• Oesophageal stricture – narrowing of the oesophagus due to scarring, which can cause trouble swallowing.
• Bleeding from the oesophagus (rare).

Long-term outlook

With proper management and regular monitoring, most people with Barrett’s oesophagus lead healthy lives and never develop cancer. If precancerous changes are found, they can often be treated successfully with endoscopic procedures. The outlook is very good when caught early.

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