Barrett's oesophagus: symptoms, diet, treatment and cancer risk

Guts UK explains that in Barrett's oesophagus the normal cells lining the gullet change and become cells that do not look normal. The change over time makes the lining resemble the lining of the bowel, which is called intestinal metaplasia. It is possible for Barrett's to lead to cancer, but Guts UK says this happens in a few people and most will not develop cancer.

Doctors can grade abnormal cells (dysplasia) as low or high grade. Guts UK says dysplasia increases the risk of cancer in Barrett's oesophagus.

Guts UK says the main symptom is reflux: heartburn (a burning feeling behind the breastbone) and bringing food back up (regurgitation), sometimes with a metallic taste or a sore throat. Symptoms are worse after lying down, and waking from reflux symptoms at night is a strong risk factor. Sometimes people do not report symptoms because the oesophagus is less sensitive to reflux, and ignoring symptoms or self-medicating with antacids can delay diagnosis.

Guts UK lists warning symptoms that should prompt you to see a doctor: trouble swallowing, frequent regurgitation or being sick after eating or drinking, pain on swallowing, weight loss, anaemia (tiredness), vomiting blood and a hoarse voice. The NHS says to see a GP if you have heartburn most days, food getting stuck in your throat, frequently being sick or losing weight for no reason.

Guts UK lists lifestyle changes aimed at reducing acid reflux: weight loss, drinking less alcohol, stopping smoking, smaller meal portions and not eating within three hours of bedtime. The NHS heartburn advice adds eating smaller, more frequent meals, avoiding food and drink that trigger your symptoms (coffee, tomatoes, alcohol, chocolate, fatty or spicy foods are commonly mentioned), not wearing tight clothes around the waist, and raising the head of your bed by around 10 to 20cm rather than adding pillows.

The NHS says these measures help symptoms. Guts UK says that lifestyle changes and medicines do not remove Barrett's oesophagus, so they do not eliminate the small risk of cancer, and that you should continue to take medical treatment if you have been diagnosed.

Guts UK says doctors diagnose it by looking at the lining of the oesophagus with an endoscopy, a small tube with a camera on the end passed through the mouth, sometimes with throat spray or sedation. Barrett's is identified by its red lining, which replaces the normal pink lining, and biopsies are taken to confirm the diagnosis and check for dysplasia.

A transnasal endoscope, which is thinner and passed through the nose, is available in some centres. The capsule sponge test, which involves swallowing a capsule on a thread that collects cells from the lining, is available in some areas of the UK for people with persistent heartburn and reflux; if it shows cell changes, you will be asked to attend for an endoscopy.

The endoscopist describes the length using the Prague classification: C is the circumferential length and M the maximum length. Guts UK gives M5C4 as an example of a segment 5cm long at its longest point and 4cm fully around the gullet.

Guts UK says people without dysplasia are at low risk of cancer and are managed with medicines (mostly proton pump inhibitors such as omeprazole or lansoprazole, which reduce stomach acid), lifestyle changes and, if these do not help, sometimes keyhole anti-reflux surgery (laparoscopic Nissen fundoplication).

For dysplasia, treatment has changed in recent years. Guts UK says endoscopic therapy at specialist centres removes or treats the affected lining without major surgery, replacing oesophagectomy for most people with high-grade dysplasia or early cancer.

Guts UK says people are usually entered into a surveillance programme with regular endoscopy and biopsies, and that capsule sponge may be offered instead in some hospitals. Guidelines suggest endoscopy every 2 to 3 years for long-segment Barrett's (3cm or more) and every 3 to 5 years for short-segment (under 3cm) with intestinal metaplasia. If low-grade dysplasia is found, a repeat endoscopy in 6 months is ordered, and people with high-grade dysplasia are quickly referred to a specialist centre.

It adds that a biopsy finding no dysplasia at one endoscopy does not mean someone will never get dysplasia or cancer, and that people with short-segment Barrett's without intestinal metaplasia would not usually be offered surveillance because they are not at increased cancer risk.

Guts UK says people with Barrett's oesophagus are 30 times more likely than the general population to develop oesophageal adenocarcinoma, but only 1 in every 300 patients with Barrett's will develop this cancer each year, which it describes as uncommon and a small risk. If cancer is found, it may be treated endoscopically, with surgery or with chemotherapy depending on stage.

Guts UK also notes that persistent reflux can sometimes cause a stricture, a narrowing of the gullet that can make swallowing hard and can be treated by stretching at endoscopy.

Guts UK says the exact cause is unknown but it is strongly linked to long-term GORD, with about 11 in 100 people with GORD getting Barrett's and the risk rising with the length of time and frequency of symptoms. Other risk factors include older age, being male (more common in white men), a family history, a higher than healthy body weight, smoking and a hiatus hernia.

On the NHS, a GP can refer you for endoscopy, and surveillance and endoscopic treatment are organised through hospital gastroenterology services and specialist centres. Guts UK suggests asking your doctor whether other medicines could be tried, how often you need an endoscopy, and whether there is a specialist nurse or support group in your area. Some people choose private endoscopy for speed; ask how results and surveillance plans will be shared with your GP.