Barrett's oesophagus: causes, symptoms, and the link to oesophageal cancer

Written by: Dr Matthew Banks
Edited by: Laura Burgess

Barrett's oesophagus is a condition that affects the bottom of the gullet or oesophagus. It is a change in the lining of the oesophagus from the normal pale colour or skin-like lining, to a salmon pink lining. Essentially, the cells are replaced by cells that are very typical of the cells in the stomach or intestines and differ from the cells lining the oesophagus. The most important aspect of Barrett's oesophagus is that in some people, a minority of those with Barrett's, there is an increased risk of oesophageal cancer.

What are the symptoms of Barrett’s oesophagus?
About 40% of people who have Barrett's oesophagus don't have any symptoms. This is because Barrett's is an active response to acid reflux. Once this is developed, there is very little inflammation to cause pain. However, 60% of patients with Barrett's have symptoms typical of acid reflux. These include heartburn, chest pain, regurgitation of food and fluid particularly at night when you lie down and recurrent belching.

Occasionally, patients with Barrett's do experience difficulty in swallowing. However, that is unusual and should be considered as a symptom of concern and will usually require investigation such as an endoscopy.

What causes Barrett’s oesophagus?
The main cause of us oesophagus is reflux of acid or gastroesophageal acid reflux. In fact, all patients with Barrett's have gastroesophageal reflux. Most patients with Barrett’s also have a hiatus hernia, which is when part of the top of the stomach comes through the diaphragm into the chest and means that the anti-reflux mechanism, or anti-reflux barrier, is slightly impaired. This allows more acid to come up from the stomach, into the oesophagus.

Who is at risk of developing Barrett’s oesophagus?
It is not due to an excessive acid, but simply more acid moving from the stomach up into the chest. Those at risk include those who are overweight, those with obesity, but also those with the family history of Barrett’s oesophagus. Now, patients with Barrett’s have an increased risk of oesophageal cancer and not everyone with Barrett’s gets oesophageal cancer. In fact, far less than 5% of those with Barrett’s oesophagus.

There are additional risk factors for oesophageal cancer. That depends on the length of the Barrett’s or the Barrett’s can be short or long, a family history of oesophageal cancer, smoking, being a man, and again obesity.

How is Barrett’s oesophagus treated?
The vast majority of patients with Barrett’s oesophagus are simply treated with anti-reflux medication. These include the proton pump inhibitors or PPI’s and it includes drugs such as omeprazole or lansoprazole. Occasionally, Barrett’s cells can change and when they do change, they become dysplastic or develop early cancer. It's therefore important to keep an eye on patients with Barrett’s with repeat endoscopies and these should be done anywhere between 1, 2, 3, 4 or even 5 years depending on the type of Barrett’s and how high the risk is.

Where there is a high risk of cancer development. It's important to treat those cells and assist on with the combination of endoscopic therapy either cutting out the abnormal cells with a procedure called endoscopic mucosal resection or EMR or burning the cells off with the treatment called radiofrequency ablation or FA with a hollow device.

Book to see a specialist who treats Barrett's oesophagus. 

By Dr Matthew Banks

Dr Matthew Banks is a leading gastroenterologist based at University College London Hospitals (UCLH) where he leads a world-renowned team. He works privately in Harley Street, the London Clinic and other prominent institutions in the capital.

Dr Banks is dedicated to education and training, holding the position of senior lecturer at The National Medical Laser Centre, University College London. Dr Banks co-hosts the largest live endoscopy conference in London and frequently runs endoscopy courses for consultants to refine their own skills. 

He is the editor of ‘Endoscopy in the Cancer Patient’ and section editor for F1000. He has published in numerous peer-reviewed journals. Dr Banks is the Secretary for the British Society of Gastroenterology Endoscopy Section, where he sits on the endoscopy committee and research committee.

Having undergone training fellowships in Sydney and Japan, Dr Banks now undertakes Endoscopic Submucosal Dissection (ESD) for early cancers and Per-oral Endoscopic Myotomy (POEM) for achalasia.

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