Barrett’s Oesophagus

Barrett’s oesophagus is a condition where the cells lining the lower part of your food pipe change structure after long-term exposure to stomach acid, creating a small but important risk factor that requires regular medical monitoring.

Table of contents

• What is Barrett’s oesophagus?
• Causes and risk factors
• Symptoms
• Cancer risk
• Diagnosis and monitoring
• Treatment
• Lifestyle changes and diet

• Oesophagus
• Lower oesophageal sphincter
• Stomach

What is Barrett’s oesophagus?

Barrett’s oesophagus is a condition that affects the lining of your oesophagus, which is the swallowing tube that carries food from your mouth to your stomach. In this condition, the normal flat pink cells lining the lower part of the oesophagus change and become more like the thick red cells normally found in your stomach and intestines.^[1]

These changes affect both the structure and appearance of your oesophagus lining. Scientists call this intestinal metaplasia, which means that tissues in your body have replaced themselves with a different type of tissue that isn’t normally found there. Your oesophagus lining normally has some protection from acids and other irritants, but not as much as your intestinal lining. The change suggests that your oesophagus is trying to protect itself from ongoing damage.^[2]

This condition does not cause symptoms on its own. However, it develops over many years as a result of long-term damage to the oesophagus. Many people with Barrett’s oesophagus have no idea they have it until it is discovered during tests for other conditions.^[2]

Causes and risk factors

Scientists don’t completely understand why Barrett’s oesophagus occurs, but it seems to relate to chronic irritation or injury inside your oesophagus. Most people who develop this condition have had gastroesophageal reflux disease (GERD) for at least 10 years. GERD is a condition where stomach acid regularly flows backward into your oesophagus, causing damage over time.^[2]

The development of Barrett’s oesophagus is most often linked to long-standing GERD. Between the oesophagus and stomach is an important valve called the lower oesophageal sphincter. Over time, this valve may begin to fail, leading to acid and chemical damage of the oesophagus. When acidic stomach contents and possibly bile wash back into the oesophagus repeatedly, they inflame and irritate the cells lining the oesophagus because these cells are not naturally acid-resistant.^[1][6]

Several factors can increase your risk of developing Barrett’s oesophagus. You may be more likely to develop this condition if you are male, as men get it two to three times more often than women. Age is also a factor, with the condition being more common in people older than 55 years, as it takes time to develop. Being white also increases risk, as Barrett’s oesophagus is most common in white populations and less common in Hispanic, Asian, and Black populations.^[2][17]

Other risk factors include being overweight, especially if you carry weight around your waist, and smoking cigarettes. If you have a family history of Barrett’s oesophagus or oesophageal cancer in a parent, sibling, or child, your risk is also higher. Between 10% and 15% of people with GERD develop Barrett’s oesophagus.^[2][5]

Symptoms

Barrett’s oesophagus itself does not produce any symptoms. Approximately half of the people diagnosed with Barrett’s oesophagus report no symptoms at all. However, if something is irritating your oesophagus lining for a long time, you are likely to have symptoms from that underlying condition.^[1][2]

About 60% of people with Barrett’s oesophagus also have symptoms of GERD, which may include frequent heartburn and regurgitation of stomach contents. Heartburn is a burning sensation felt behind the breastbone. You may also experience difficulty swallowing food, chest pain, or the feeling or taste of stomach juices backwashing into your oesophagus after you eat.^[1][11]

Chronic oesophagitis, which is inflammation in your oesophagus, may feel like heartburn or chest pain in the lower chest area, or like a sore throat if the inflammation is higher up. It may make your oesophagus feel swollen or cause difficulties swallowing. It takes years of chronic oesophagitis to damage your oesophagus tissues enough to trigger the cellular changes seen in Barrett’s oesophagus.^[2]

Cancer risk

Barrett’s oesophagus is associated with an increased risk of developing oesophageal cancer, specifically a type called oesophageal adenocarcinoma. However, it is important to understand that although the risk exists, it is quite small. The risk of developing oesophageal cancer is only about half a percent per year.^[2]

Between 3 and 13 people out of 100 with Barrett’s oesophagus in the UK will develop oesophageal adenocarcinoma in their lifetime. Each year, less than 1 in 100 people with Barrett’s oesophagus develop this type of cancer. Most people with Barrett’s oesophagus do not develop cancer.^[5]

Cellular changes happen slowly, and Barrett’s oesophagus passes through another stage before progressing to cancer. This stage is called dysplasia, which means the cells show abnormal growth. Dysplasia can be classified as low-grade or high-grade. Low-grade dysplasia means cells show small signs of changes that could become cancerous. High-grade dysplasia means cells show many changes and is thought to be the final step before cells change into oesophageal cancer.^[7]

Your risk of developing oesophageal cancer is higher if you have more severe cell changes, particularly high-grade dysplasia. This is why regular monitoring is so important. If your healthcare provider notices any dysplasia, they can remove it to stop it from progressing further.^[2][5]

Diagnosis and monitoring

Doctors generally use a test called endoscopy (also called gastroscopy or upper gastrointestinal endoscopy) to determine if you have Barrett’s oesophagus. During this test, a doctor passes a long flexible tube with a light and camera at the end down your throat and into your oesophagus. The camera allows the doctor to see the lining of your oesophagus clearly.^[7]

Normal oesophagus tissue appears pale and glossy. In Barrett’s oesophagus, the tissue appears red and velvety, showing a distinct change in appearance. During the endoscopy, your doctor will remove small tissue samples, called biopsies, from different parts of your oesophagus. These samples are sent to a laboratory where they are examined under a microscope to determine the degree of change in the cells.^[7]

A doctor who specializes in examining tissue in a laboratory, called a pathologist, determines whether Barrett’s oesophagus is present and whether there is any dysplasia in your oesophagus cells. Because it can be difficult to diagnose dysplasia in the oesophagus, it is best to have two pathologists agree on your diagnosis.^[7]

In some areas, doctors may use a newer test called a capsule sponge test, which includes products like Cytosponge or EndoSign. This is a small capsule that you swallow with water. The capsule contains a sponge attached to a string. After about 5 minutes, the covering on the capsule dissolves in your stomach, and a nurse gently removes the sponge by pulling the string. As the sponge is pulled up through your oesophagus, it collects cells from the lining. These cells are then sent to a laboratory for examination.^[5]

If you are diagnosed with Barrett’s oesophagus, you will need regular follow-up examinations. How often you have tests depends on your condition and whether it is changing. Regular monitoring can detect any changes early, when they are easiest to treat. If you have Barrett’s oesophagus with no dysplasia, you may need a follow-up endoscopy every two to three years. If dysplasia is found, you will need more frequent monitoring.^[4][10]

Treatment

Treatment for Barrett’s oesophagus focuses on two main goals: controlling acid reflux to prevent the condition from getting worse, and treating any abnormal cell changes to prevent cancer from developing. The specific treatment depends on whether dysplasia is present and how severe it is.^[4]

If you have Barrett’s oesophagus and GERD, your doctor will likely suggest medicines called proton pump inhibitors (PPIs). These medicines lower the amount of acid your stomach makes. PPIs can prevent further damage to your oesophagus and, in some cases, heal existing damage. Some studies have shown that PPIs may lower your chances of developing high-grade dysplasia and oesophageal cancer. PPIs are generally safe and effective, though your doctor will discuss the risks and benefits of taking them for a long period.^[9]

If abnormal cells or dysplasia are found, doctors may use treatments during an endoscopy to remove or destroy these cells. One recommended procedure is radiofrequency ablation (RFA), which uses heat made by radiowaves to kill abnormal cells. During this procedure, your doctor puts a probe down the endoscope, and the probe creates an electrical current that heats the abnormal cells to high temperatures and destroys them.^[9][10]

Another treatment option is endoscopic mucosal resection (EMR), where doctors remove abnormal areas from the lining of the oesophagus. Your doctor uses a thin wire called a snare, passed down the endoscope, to remove the abnormal areas in the inner lining. You may have RFA after endoscopic surgery to destroy any remaining abnormal cells in the area.^[10]

Doctors may also use cryotherapy, which uses cold liquid nitrogen to get rid of abnormal cells in your oesophagus. In some cases, doctors might recommend surgery to strengthen the valve at the lower end of your oesophagus. This operation is called laparoscopic fundoplication, and it stops acid from the stomach going back up into the oesophagus.^[9][10]

In rare cases where cancer has developed, your doctor may recommend a surgery called oesophagectomy to remove the affected sections of your oesophagus. However, surgery is less common than other ways to treat Barrett’s oesophagus and may not be an option for everyone.^[9]

Lifestyle changes and diet

Making lifestyle changes can help manage GERD symptoms and may help prevent Barrett’s oesophagus from getting worse. These changes focus on reducing the amount of acid that flows back into your oesophagus and supporting overall digestive health.^[4]

Getting plenty of fiber in your daily diet is good for your overall health. Medical research shows that it may also help prevent Barrett’s oesophagus from worsening and lower your risk of cancer in the oesophagus. You can add fiber-rich foods to your daily diet, including fresh, frozen, and dried fruit; fresh and frozen vegetables; whole-grain breads and pasta; brown rice; beans; lentils; oats; and couscous.^[15]

If you have GERD, avoiding certain foods and drinks may help reduce symptoms. Foods and drinks commonly linked to GERD symptoms include acidic foods such as citrus fruits and tomatoes, alcoholic drinks, chocolate, coffee and other sources of caffeine, high-fat foods, mint, and spicy foods. Eating too many refined sugary foods may also increase problems, so limiting these foods is recommended.^[18][15]

If you have GERD symptoms at night or when you’re lying down, eating meals at least 3 hours before you lie down may improve symptoms. Eating large portions at meals can also worsen reflux, so eating smaller meals throughout the day may help.^[18][11]

Other helpful lifestyle changes include avoiding tobacco use, as smoking may be a contributing factor to Barrett’s oesophagus. If you are overweight, your doctor may suggest you reach and maintain a healthy weight to help reduce GERD symptoms. Weight loss is particularly important if you carry excess weight around your waist area.^[18][2]

Early detection and treatment of GERD may help prevent Barrett’s oesophagus from developing or worsening. If you have frequent heartburn or any chronic symptoms related to acid reflux, even if they are mild or come and go, it is important to check in with a healthcare provider. Regular monitoring and following your treatment plan can help manage the condition and reduce the risk of complications.^[4]