Barretts Oesophagus

Overview

Barrett's oesophagus is a condition where the pink lining of the lower food pipe (oesophagus) becomes damaged and changes to look a bit like the lining of the stomach. This usually happens after many years of stomach acid washing up into the food pipe, a problem called acid reflux. Barrett's oesophagus itself does not cause symptoms, but it is important to monitor because it slightly increases the risk of developing oesophageal cancer in the future.

About 1 to 2 in every 100 adults have Barrett's oesophagus. It is more common in people who have had acid reflux for many years.

It affects men more often than women, and it is usually diagnosed in people over the age of 50. You are also more likely to develop it if you are overweight, smoke, or have a family history of Barrett's oesophagus.

Symptoms

Common symptoms

• Barrett's oesophagus itself does not cause symptoms. The usual symptoms are from the acid reflux that leads to it, including heartburn (a burning feeling in the chest).
• Regurgitation of food or sour liquid.
• Difficulty swallowing or a feeling that food gets stuck.
• A chronic cough, hoarse voice, or sore throat, especially in the morning.

Symptoms in children

• Barrett's oesophagus is very rare in children. When it does occur, it usually causes reflux symptoms such as vomiting, poor weight gain, or a persistent cough.

Symptoms in older adults

• Older adults may have fewer heartburn symptoms but may notice more difficulty swallowing, unintentional weight loss, or anaemia (feeling tired and pale). These symptoms should always be checked by a doctor.

Causes

Main causes

• Long-term acid reflux: Repeated exposure to stomach acid injures the lining of the oesophagus, causing it to change into a more protective type of lining.
• A hiatal hernia: A condition where part of the stomach bulges up into the chest, making reflux worse.

Risk factors

• Being over 50 years old.
• Being male.
• Having had reflux symptoms for more than 5 years.
• Carrying extra weight around the abdomen.
• Smoking.
• Having a family member with Barrett's oesophagus or oesophageal cancer.

When to see a doctor

See a doctor urgently if:

• If you have difficulty swallowing or feel food getting stuck in your chest.
• If you are losing weight without trying.
• If you vomit blood or pass black stools.

Book a routine appointment if:

• If you have heartburn or acid reflux on most days for more than three weeks.
• If you need to take over-the-counter antacids more than twice a week.
• If you are over 50 and have any new or persistent digestive symptoms.

Diagnosis

Barrett's oesophagus is usually diagnosed with an endoscopy, a procedure where a thin, flexible tube with a camera is passed down your throat into your oesophagus. If the doctor sees any suspicious areas, they will take a small tissue sample, called a biopsy, to look at under a microscope.

Tests that may be done

• Endoscopy (also called upper endoscopy or gastroscopy).
• Biopsy of the oesophageal lining.
• Sometimes special dyes or advanced imaging are used during the endoscopy to help the doctor see the affected area more clearly.

What to expect at your appointment

An endoscopy is usually done as a day procedure. You will be given a sedative to help you relax, and a spray to numb your throat. The test takes about 15 minutes. Afterwards, you may have a mild sore throat, but this settles quickly. You will likely need someone to take you home because of the sedative.

Treatment

The main goals of treatment are to control acid reflux symptoms, heal the lining of the oesophagus, and monitor for any changes that could lead to cancer. Treatment should always be guided by a healthcare professional.

Self-care at home

• Lose weight if you are overweight.
• Raise the head of your bed by 10–20 cm (for example, with a bed wedge) to stop acid washing up at night.
• Avoid eating large meals, especially within 3 hours of going to bed.
• Quit smoking and limit alcohol.
• Avoid foods that trigger your reflux, such as spicy, fatty, or acidic foods.

Medical treatments

Doctors often prescribe medicines that reduce stomach acid, such as a group of drugs called proton pump inhibitors (PPIs) or H2-receptor blockers. These help relieve reflux symptoms and allow the lining to heal. In some cases, you may also be advised to take antacids for quick relief. Your doctor will explain which treatment is right for you. You should not take any acid-suppressing medicine without consulting a doctor.

When is surgery considered?

Surgery is not usually needed for Barrett's oesophagus itself. However, if reflux is very severe and medicines are not controlling it, an operation called fundoplication (wrapping the top of the stomach around the lower oesophagus) may be considered. If the biopsy shows advanced cell changes, procedures may be done to remove the abnormal lining. Otherwise, regular monitoring with endoscopy is the standard approach.

Living with this condition

Most people with Barrett's oesophagus live normal lives and manage their condition with regular check-ups and by following their doctor's advice. Try to keep a diary of symptoms to discuss with your healthcare team.

Lifestyle tips

• Take your prescribed medicines exactly as directed.
• Keep your follow-up endoscopy appointments—even if you feel well.
• Stay active and maintain a healthy weight.
• Avoid heavy lifting or straining if you have a hiatal hernia.
• Learn to recognize the symptoms that should prompt urgent medical advice.

Diet and exercise

Eat a balanced diet with plenty of fruit, vegetables, and whole grains. Have smaller, more frequent meals rather than large ones. Aim for regular, moderate exercise like walking or swimming to help with weight management and overall health. Avoid eating close to bedtime.

Mental health and emotional wellbeing

Receiving a diagnosis of Barrett's oesophagus can feel worrying, especially because of the link to cancer. It is normal to feel anxious. Remember that most people with Barrett's never develop cancer, and regular monitoring greatly reduces the risk. If anxiety affects your daily life, speak to your doctor about counseling or other support.

Prevention

You cannot always prevent Barrett's oesophagus, but you can reduce your risk by managing acid reflux early. If you have persistent heartburn, see a doctor rather than ignoring it. Maintaining a healthy weight, not smoking, and limiting alcohol may also lower the chances of developing it.

Screening programmes

Routine screening for the general public is not currently recommended. However, if you have long-term reflux symptoms, especially with other risk factors, your doctor may recommend an endoscopy to check for Barrett's oesophagus. This is a decision made individually with your healthcare provider.

Complications

If left untreated

• Oesophageal stricture: A narrowing of the oesophagus due to scarring, which can make swallowing difficult.
• Oesophageal ulcer: An open sore in the lining, which can bleed and cause pain.
• Dysplasia: Abnormal changes in the cells of the Barrett's lining, which can be low-grade or high-grade.
• Oesophageal cancer: A small but real risk, especially if high-grade dysplasia is present.

Long-term outlook

The outlook for Barrett's oesophagus is generally very good, especially with proper monitoring and treatment. The risk of developing oesophageal cancer is small, and regular endoscopies help catch any changes at an early, treatable stage. Most people with Barrett's oesophagus never develop cancer. By working closely with your healthcare team, you can take positive steps to protect your health for years to come.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.