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Barrett's oesophagus


Expert reviewer, Dr Jason Dunn, Consultant Gastroenterologist
Next review due March 2024

Barrett's oesophagus is when the lining of your lower oesophagus (food pipe) is damaged. It’s caused by acid and bile coming back up from your stomach. Over time, the cells of the lining can become abnormal and there’s a small risk of cancer developing. But most people with Barrett’s oesophagus do not get cancer.

Image showing the digestive system

What is Barrett's oesophagus?

Barrett’s oesophagus is named after the surgeon who first described it. It affects up to two in every 100 people, and is more common in men. You can get it at any age, but most people diagnosed are over 50.

Your oesophagus (food pipe) is the tube that joins your mouth to your stomach. When acid and bile come back up your oesophagus from your stomach, this is known as gastro-oesophageal reflux disease (GORD) or acid reflux. Over time, the acid and bile from your stomach can cause the cells in the lower part of your oesophagus to change. Around one in 10 people who have acid reflux for a long time develop Barrett's oesophagus.

Sometimes, these changed cells can become pre-cancerous and eventually cancerous. Doctors call precancerous cells dysplasia (diss-play-zee-ah). Cells that are only slightly abnormal are known as low-grade dysplasia; cells that are more abnormal are known as high-grade dysplasia. The level of dysplasia of your cells determines if you need treatment and what treatment you have.

So, if you have Barrett’s oesophagus, your doctor may ask you to have regular checks for very early signs of cancer.

Symptoms of Barrett's osesophagus

You may not have any symptoms from Barrett’s oesophagus. But you may have symptoms of gastro-oesophageal reflux disease (GORD), which causes Barrett’s oesophagus. Symptoms of GORD include:

  • heartburn
  • acid coming up into the back of your mouth
  • food coming back up (regurgitation)

Other symptoms can include a sore throat and hoarse voice, caused by the acid reflux, but these are less common. Acid reflux may also cause coughing or wheezing.

Your pharmacist can suggest treatments to help with heartburn or indigestion. But if your symptoms continue, see your GP for advice.

It’s very important to have your symptoms checked if you have GORD. You may have Barrett’s oesophagus that hasn’t been diagnosed. If you do, your doctor can give you treatment and check-ups aimed at preventing cancer or picking it up at an early stage.

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Diagnosis of Barrett's oesophagus

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

Your GP may arrange for you to have a test at the hospital called a gastroscopy. In this procedure, a gastroscope is put into your mouth or nose and down into your stomach. A gastroscope is a narrow, flexible tube with a camera on the end so your doctor can see inside your oesophagus and stomach. Your doctor or nurse will usually take small samples of tissue (biopsies) from the lining of your oesophagus. They send these to a laboratory to check for any abnormal cells.

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

If you have Barrett's oesophagus, your doctor may want to monitor your condition. If so, they’ll arrange for you to have regular gastroscopies with biopsies. These will help to pick up any abnormal changes (dysplasia) that could develop. Your doctor may recommend you have a gastroscopy every six months to five years. This depends on how abnormal your cells are and how much of your oesophagus is affected.

You don’t always need to have Barrett's oesophagus monitored in this way. Your doctor will talk to you about the pros and cons of regular monitoring, and what might be best for you.

Self-help for Barrett's oesophagus

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

  • lose weight if you’re overweight
  • stop smoking
  • avoid food and drinks that make symptoms worse
  • eat smaller meals at regular intervals, rather than a large portion in one go
  • use an extra pillow or two or raise the head of the bed if you get symptoms at night
  • sit upright when you eat and don’t lie down immediately after eating

Barrett’s oesophagus and diet

It may help to keep a food and symptom diary (PDF, 1.4MB), to find out which foods make your symptoms worse. Everyone’s different, but some people find that fatty, spicy or acidic foods, alcohol and caffeine can cause indigestion and reflux. Depending on the findings from your diary, you may find it helpful to:

  • grill foods instead of frying
  • avoid fatty and processed meats and cheese
  • cut down on coffee, chocolate and soft drinks containing caffeine, including energy drinks
  • cut down or avoid alcohol and fizzy drinks
  • avoid acidic foods, such as tomatoes, citrus fruits and juices
  • avoid spicy foods (although if this is your main diet, they may help)
  • avoid acidic sauces and condiments, such as ketchup, mustard and vinegar

Your eating patterns can also affect your symptoms. So you may find it helpful to eat regular meals, particularly making sure you have breakfast, and avoid snacking late in the evening.

Treatment for Barrett's oesophagus

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

Medicines

Your doctor may prescribe medicines to reduce the amount of stomach acid you produce. This should help to reduce gastro-oesophageal reflux. You may have 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 ask the specialist to see you again to discuss further treatment.

Non-surgical treatment

If tests show that you have pre-cancerous cells, you may need monitoring with further gastroscopies or treatment. A team of doctors will look at your results and recommend the best options for treatment in your individual circumstances. Your own wishes will also be taken into account.

They may suggest treatment to remove the layer of damaged cells using a gastroscope. This is called endoscopic treatment. It allows healthy cells to regrow over the area.

Endoscopic treatments include the following.

  • Radiofrequency ablation uses heat made by radio waves to destroy abnormal cells. This is the most common way to treat Barrett’s oesophagus. Your doctor uses a probe to destroy abnormal cells in your oesophagus.
  • Endoscopic mucosal resection is a treatment to remove outgrowths of affected tissue from the wall of your oesophagus. This is often used to remove very early cancer of the oesophagus. You may have radiofrequency ablation afterwards. This is to help get rid of any remaining damaged cells.

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

Surgery

There are two types of surgery for Barrett's oesophagus.

Fundoplication

This operation strengthens the valve at the bottom of your oesophagus. The aim is to prevent further gastro-oesophageal reflux. Fundoplication surgery can help if your symptoms are really bothering you but you don’t want to take medicines for the long term. It may also be an option if you have side-effects from acid-reducing medicines.

Oesophagectomy

Your doctor may suggest this operation if you’ve developed an early cancer. Your surgeon will remove the affected section of your oesophagus. They then join your stomach to the remaining part.

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 come up from your stomach into your oesophagus.

Usually, stomach contents are kept in your stomach by a muscular valve. If you have Barrett's oesophagus, this valve may have become weak or moved out of place. Acid and bile from your stomach can then leak upwards. The cells lining your oesophagus become inflamed and damaged. They eventually get replaced by new cells which are more like the cells that line your stomach. This is your body’s way of protecting the lining of your 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 every 10 people with chronic 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 sometimes lead to a type of oesophageal cancer. But the risk of developing precancerous cells is low. Most people with Barrett’s oesophagus do not get cancer.

People who develop cancer have usually had Barrett’s oesophagus for many years. The cancer risk is much lower if you’ve had endoscopic treatment. For more information on this, see our section on treatment above.

If you have Barrett’s oesophagus, you may get complications linked to gastro-oesophageal reflux. These include:

  • inflammation of your oesophagus (oesophagitis) – your oesophagus is damaged by stomach acid and this can lead to ulcers
  • scarring of your oesophagus (stricture) – this can narrow your oesophagus and make swallowing more difficult

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 can develop in some people who’ve had Barrett's oesophagus. But squamous cell carcinoma isn't linked to Barrett’s. So you may get it without having Barrett’s oesophagus first.

  • Yes, radiofrequency ablation therapy can often cure Barrett's oesophagus. Radiofrequency ablation uses a probe and heat made by radio waves to destroy abnormal cells in your oesophagus. Your doctor will only recommended radiofrequency ablation if the cells lining your oesophagus have become precancerous (dysplasia).

    After treatment, your risk of oesophageal cancer will be significantly lower. But there is a small risk that the Barrett’s could come back. So your doctor will continue to monitor you. For more information on this, see our section on treatment above.

  • Most people with Barrett's oesophagus don't go on to develop cancer. But each year one in 200 people who have Barrett’s oesophagus without precancerous cells will develop oesophageal cancer. But it usually takes many years for cancer to develop.

    If you have Barrett’s oesophagus, it’s important to follow any advice your doctor gives you and to attend regular check-ups This will help your doctor to spot any abnormal changes as early as possible if a cancer does start to develop.

  • Barrett’s oesophagus isn’t serious in itself. You might even have Barrett’s oesophagus without experiencing any symptoms. But it can sometimes lead to oesophageal cancer, which is serious.

    Most people with Barrett’s oesophagus don’t go on to develop cancer. But it’s important to attend regular check-ups so your doctor can detect and treat any potential problems as early as possible.



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Related information

    • Barrett's oesophagus. BMJ Best Practice. bestpractice.bmj.com, last reviewed January 2021
    • Barrett's oesophagus. Patient. patient.info, last updated January 2017
    • Gastroesophageal reflux disease. Medscape. emedicine.medscape.com, last updated October 2020
    • Gastrointestinal medicine Oxford Handbook of General Practice. 5th ed. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
    • Guidelines on the diagnosis and management of Barrett's oesophagus. British Society of Gastroenterology. bsg.org.uk, published October 2013
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE). nice.org.uk, last updated January 2021
    • Revised British Society of Gastroenterology recommendation on the diagnosis and management of Barrett’s oesophagus with low-grade dysplasia. British Society of Gastroenterology. bsg.org.uk, published April 2017
    • Barrett's esophagus treatment and management. Medscape. emedicine.medscape.com, updated December 2017
    • GERD, Barrett's esophagus and the risk for esophageal cancer. American Society for Gastrointestinal Endoscopy. asge.org, accessed March 2021
    • Gastroesophageal reflux disease treatment and management. Medscape. emedicine.medscape.com, last updated October 2020
    • Pesce M, Cargiolli M, Cassarano S, et al. Diet and functional dyspepsia: clinical correlates and therapeutic perspectives. World J Gastroenterol 2020; 26(5):456–65. doi:10.3748/wjg.v26.i5.456
    • Nutrition in gastrointestinal diseases. Oxford Handbook of Nutrition and Dietetics. 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published online April 2020
    • Duncanson KR, Talley NJ, Walker MM, et al. Food and functional dyspepsia: a systematic review. J Hum Nutr Diet 2018; 31(3):390–407. doi:10.1111/jhn.12506
    • Gastro-oesophageal reflux disease. NICE British National Formulary. bnf.nice.org.uk, accessed March 2020
    • Personal communication, Dr Jason Dunn, Consultant Gastroenterologist, March 2021
    • Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence (NICE). nice.org.uk, last updated October 2019
    • Treatment for Barrett's oesophagus. Cancer Research UK. cancerresearchuk.org, last updated November 2019
    • Endoscopic mucosal resection – removing the lining of the oesophagus. Cancer Research UK. cancerresearchuk.org, last updated October 2019
    • Surgery to remove your oesophagus. Cancer Research UK. cancerresearchuk.org, last updated December 2019
    • Barrett esophagus. Medscape. emedicine.medscape.com, last updated December 2017
    • Reed CC, Shaheen NJ. Management of Barrett esophagus following radiofrequency ablation. Gastroenterol Hepatol 2019; 15(7):377–86

  • Reviewed by Liz Woolf, Freelance Health Editor, March 2021
    Expert reviewer, Dr Jason Dunn, Consultant Gastroenterologist
    Next review due March 2024

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