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Barrett's oesophagus


Expert reviewer, Dr Ian Arnott, Consultant Gastroenterologist
Next review due October 2021

Barrett's oesophagus is when the cells lining the lower part of your oesophagus (gullet) get damaged by acid and bile repeatedly coming up from your stomach. Over time, the cells may become abnormal and there’s a small risk that cancer will develop.

If you have Barrett’s oesophagus, your doctor may recommend you have regular checks for very early signs of cancer. These checks are done with a narrow, flexible tube-like camera called a gastroscope. You can then have treatment to stop the cancer developing.

You may find it reassuring to know that most people with Barrett’s oesophagus do not develop cancer.

Image showing the digestive system

About Barrett's oesophagus

Your oesophagus (gullet) is part of your digestive system – it’s the tube that goes from your mouth to your stomach. The medical term for acid and bile travelling back up from your stomach is gastro-oesophageal reflux. You may also hear it called acid reflux.

Barrett's oesophagus can develop if you have gastro-oesophageal reflux for a long time – probably at least five years. Acid and bile that travels up from your stomach may eventually cause the flat, skin-like cells in the lower part of your oesophagus to change. They become more like the cells that line your stomach and small intestine. These changed cells have an increased risk of becoming cancerous.

When these cells change to become precancerous, this is called dysplasia. Under the microscope, cells may be described as having low-grade (less) or high-grade (more) dysplasia. The degree of dysplasia will affect whether you need treatment and what treatment you have.

Barrett’s oesophagus is named after the surgeon who first described the condition. It affects around two people in a hundred, and is more common in men. Most people who get it are over 50.

Symptoms of Barrett's osesophagus

Barrett’s oesophagus doesn't cause any symptoms on its own, so you may have none. Or you may have symptoms of gastro-oesophageal reflux, which can cause Barrett’s oesophagus. The symptoms of gastro-oesophageal reflux include:

  • heartburn
  • acid coming up into the back of your mouth
  • food coming back up the wrong way

If you have heartburn or indigestion, a pharmacist will be able to advise you on treatments that can help. But if your symptoms continue, contact your GP for advice.

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Diagnosis of Barrett's oesophagus

Your GP will ask about your symptoms and may examine you. They may also ask you about your medical history.

Your GP may arrange for you to have a test called a gastroscopy. A specialist doctor called a gastroenterologist or specialist nurse will look inside your oesophagus and stomach using a narrow, flexible, tube-like telescopic camera (gastroscope). It can help your doctor to tell whether you have Barrett’s oesophagus or not. You can find out more about this procedure from our information on gastroscopy.

During the gastroscopy, your doctor or nurse may need to take small samples of tissue (biopsies) from the lining of your oesophagus. They’ll send these to a laboratory to look for abnormal cells.

Barrett's oesophagus is often only picked up when you have a gastroscopy to investigate another problem, such as abdominal (tummy) pain.

If you have Barrett's oesophagus, your gastroenterologist may want to monitor your condition. If so, they’ll arrange for you to have regular gastroscopies with biopsies. These will help to detect any abnormal changes that may develop in the cells in your oesophagus. Your doctor may recommend these from every few months to every five years, depending on how severe your condition is.

It’s not always necessary to monitor Barrett's oesophagus in this way. Your doctor will discuss with you the pros and cons of regular monitoring, and what might be best in your individual circumstances.

Self-help for Barrett's oesophagus

Your doctor may advise you to make some changes to your lifestyle to help reduce gastro-oesophageal reflux. This won’t get rid of the Barrett’s oesophagus, but it may help control your symptoms. For example, they might suggest you:

  • lose any excess weight
  • stop smoking
  • drink less alcohol and coffee
  • avoid foods that aggravate your symptoms, such as fatty foods (keep a diary so you know which foods make your symptoms worse)
  • eat smaller meals at regular intervals, rather than a large amount in one go
  • use an extra pillow or two or raise the head of the bed if you get reflux symptoms at night

You may find it helpful to read our information on indigestion.

Treatment for Barrett's oesophagus

Treatments for Barrett's oesophagus aim to prevent further gastro-oesophageal reflux and, if necessary, remove any damaged areas of tissue from your oesophagus.

Medicines

Your doctor may prescribe you medicines to reduce the amount of stomach acid you produce. This should in turn reduce gastro-oesophageal reflux. They’ll usually prescribe you medicines called proton pump inhibitors. You may need to take these medicines long-term to control your symptoms.

If medicines don't work, your GP may refer you back to or seek advice from your gastroenterologist to talk about more options.

Non-surgical treatment

If tests show that you have abnormal cells which might turn into cancer (precancerous cells), you may need monitoring with further gastroscopies or treatment. A team of doctors and other cancer specialists will look at your results and recommend the best option for treatment in your individual circumstances. Your own wishes will also be taken into account.

In some hospitals, doctors may be able to offer treatments to remove the layer of damaged cells using a gastroscope (called endoscopic treatments). Healthy cells usually regrow over the area after this.

Endoscopic treatments include the following.

  • Radiofrequency ablation uses heat made by radio waves to destroy the abnormal cells. Your doctor will use a probe to apply an electrical current to the abnormal cells in your oesophagus. This will heat them up until they’re destroyed. This is the most common way to treat this condition.
  • Endoscopic mucosal resection is a treatment to remove any outgrowths of affected tissue from the wall of your oesophagus. This technique is often used to remove very early cancer of the oesophagus. Your doctor may use ablation therapy after this, to help get rid of any other damaged cells.
  • Photodynamic therapy uses a laser to deliver light energy to destroy the abnormal cells in your oesophagus. You’ll first be given a special medicine, called a photosensitising agent, which makes the abnormal cells sensitive to light.

Your doctor or surgeon will tell you if any of these treatments are suitable for you. They might not be available in all hospitals, and you may need to be referred to a hospital that specialises in them.

Surgery

If your gastroenterologist thinks you may benefit from surgery, they’ll refer you to a surgeon to discuss your options. There are two types of surgery for Barrett's oesophagus.

Fundoplication

This is an operation to strengthen the valve at the bottom of your oesophagus, which prevents further gastro-oesophageal reflux. Your doctor may recommend this surgery if your symptoms are really bothering you but you don’t want to take medicines long term. It may also be an option if you have side-effects from acid-reducing medicines. You can find out what’s involved in this operation from our information on fundoplication.

Oesophagectomy

This is an operation to remove the affected area of your oesophagus. Your doctor may advise you to have this operation if you’ve developed an early cancer as a complication of Barrett’s oesophagus. In this operation, your surgeon will remove the affected section of your oesophagus and then join your stomach to the remaining part. For more, see our information on oesophageal cancer.

Causes of Barrett's oesophagus

Barrett's oesophagus is caused by long-term reflux of acid and bile. This is when stomach acid and digestive juices travel upwards from your stomach into the lower part of your oesophagus.

Usually, stomach contents are kept in your stomach by a muscular valve that stops them from reaching your oesophagus. But if you have Barrett's oesophagus, your valve may have become weak or moved out of place, which allows acid and bile to leak upwards. The cells lining your oesophagus become inflamed and damaged. They eventually get replaced by new cells which are more like those lining the stomach. This is probably your body’s way of protecting the lining of the oesophagus from further damage.

You're more likely to get Barrett’s oesophagus if you have long-term reflux and you:

  • are male
  • are white
  • are over 50
  • have someone else in your close family with the condition
  • have a hiatus hernia
  • smoke
  • are overweight

Only about one in 20 people who have reflux go on to develop Barrett's oesophagus. You're more likely to develop it if you’ve had severe reflux symptoms for many years.

Complications of Barrett's oesophagus

The most important complication of Barrett’s oesophagus is that it can develop into cancer. Each year, for every 200 people with Barrett’s oesophagus, one will develop oesophageal cancer. This means that most people with Barrett’s oesophagus do not get cancer. And you may have Barrett’s oesophagus for many years before cancer develops. The risk of developing cancer is much lower for people who have endoscopic treatment (see our section on treatment above).

Since it’s usually caused by gastro-oesophageal reflux, if you have Barrett’s oesophagus you may get complications linked to that reflux. These include:

  • inflammation of your oesophagus (oesophagitis); your oesophagus can become damaged by the acid from your stomach and this can lead to ulcers)
  • scarring of your oesophagus (stricture); this may narrow your oesophagus and make it difficult to swallow

Frequently asked questions

  • No, not everyone with oesophageal cancer will have had Barrett's oesophagus first.

    There are two types of oesophageal cancer – adenocarcinoma and squamous cell carcinoma. Adenocarcinoma usually develops in people who have Barrett's oesophagus, but squamous cell carcinoma isn't linked to Barrett’s. So you can develop this type of cancer without having Barrett’s oesophagus first.

  • Yes, radiofrequency ablation therapy can often cure Barrett's oesophagus. See our treatment section above to find out more about this procedure. After treatment, your risk of oesophageal cancer will be significantly lower.

    Doctor’s don’t recommend radiofrequency ablation for everyone with Barrett’s oesophagus. It’s usually only recommended if the cells lining your oesophagus show signs of being precancerous (dysplasia). This is because, as with all procedures, there are some risks with having radiofrequency ablation. These include getting areas of narrowing (strictures), punctures in your oesophagus, and bleeding.

    Ask your doctor for more information about the potential benefits and risks of radiofrequency ablation and if it's an option for you.

  • Most people with Barrett's oesophagus don't go on to develop cancer at all. For every 200 people with Barrett’s oesophagus, only one will go on to get oesophageal cancer each year. And it usually takes many years for the cancer to develop. Cells in the damaged area of the oesophagus go through a number of changes before they become cancerous, and this takes time.

    Certain things can increase your risk of progressing to oesophageal cancer. It’s more likely to happen in men, and other risks include:

    • getting older
    • smoking
    • how much of your oesophagus is affected by Barrett's oesophagus; the more that’s affected, the higher your risk
    • how long you’ve been having gastro-oesophageal reflux; the longer this has been happening, the higher the risk

    If you have Barrett’s oesophagus, it’s important to follow any advice your doctor gives you and to attend any appointments for monitoring your condition. This will give you the best chance of cure if a cancer does start to develop. But remember, in most cases Barrett’s oesophagus does not become cancer.


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Related information

    • Barrett's oesophagus. BMJ Best practice. bestpractice.bmj.com, last reviewed August 2018
    • Oesophageal cancer. BMJ Best practice. bestpractice.bmj.com, last reviewed November 2018
    • Barrett esophagus. Medscape. www.emedicine.medscape.com, updated December 2017
    • Barrett's oesophagus. PatientPlus. patient.info/patientplus, last checked January 2017
    • Gastro-oesophageal reflux disease. PatientPlus. patient.info/patientplus, last checked March 2016
    • Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
    • Endoscopic radiofrequency ablation for Barrett's oesophagus with low-grade dysplasia or no dysplasia. National Institute for Health and Care Excellence (NICE), 2014. www.nice.org.uk
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), 2015, last updated 2017. www.nice.org.uk
    • Gastro-oesophageal reflux disease. NICE British National Formulary. bnf.nice.org.uk, accessed October 2018
    • Gastroenterology – Gastro-oesophageal reflux disease (GORD). Oxford Handbook of Clinical Medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, published September 2017
    • Gastrointestinal medicine – oesophageal conditions. Oxford Handbook of General Practice (online). Oxford Medicine Online.com, published April 2014
    • Barrett’s oesophagus. Cancer Research UK. www.cancerresearchuk.org, last reviewed May 2016
    • Oesophageal cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed October 2016
    • Fitzgerald RC, Di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus. Gut 2014; 63(1):7–42. doi:10.1136/gutjnl-2013-305372
    • Barrett’s oesophagus. Guts UK! 2018. gutscharity.org.uk
    • Barrett’s esophagus. National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov, published March 2017
    • Personal communication, Dr Ian Arnott, Consultant Gastroenterologist, October 2018

  • Reviewed by Dr Kristina Routh, Freelance Health Editor, October 2018
    Expert reviewer, Dr Ian Arnott, Consultant Gastroenterologist
    Next review due October 2021



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