Skip to main content
search here
username password
Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more| .
How we produce our information|
The oesophagus is the muscular tube that carries food from the mouth to the stomach. Barrett's oesophagus is a condition in which abnormal cells develop on the inner lining of the lower part of the gullet (oesophagus).
Barrett's oesophagus is not in itself a cancerous condition, but over a period of time it can occasionally lead to cancer developing in the lower part of the oesophagus. A cancer happens when cells in the affected area continue to grow and reproduce and become increasingly abnormal. Approximately 1–2 out of every 200 people in the UK have Barrett's oesophagus; however, very few people with this condition go on to develop cancer (about 1 in 100 each year).
The digestive system
This is when the valve at the lower end of the oesophagus (gullet) is weak and allows the stomach contents to 'splash' up into the oesophagus. Reflux disease is very common and many people experience symptoms from time to time.
Certain factors can make people more likely to have reflux. These include:
Reflux is often also caused by a hiatus hernia. A hiatus hernia happens when a small piece of the stomach is displaced and pokes through the sheet of muscle (the diaphragm) that divides the chest from the abdomen.
The stomach produces acid, and the stomach juices contain bile and proteins, which help to digest food. The stomach is lined by tissue that is resistant to acid, but the oesophagus is not. The acid may inflame and irritate the oesophagus, and, in some people, will cause symptoms of pain and heartburn. This is often referred to as gastro-oesophageal reflux disease (GORD) orreflux oesophagitis .
Not everyone who has acid reflux will develop Barrett's oesophagus. Up to 1 in 10 (10%) of people with acid reflux will go on to develop it. This is more likely to happen in people who have had severe reflux symptoms for many years, in men and in people over 50.
A small number of people will experience changes in the cells of the oesophagus. These changes in the cells are sometimes called dysplasia . They are pre-cancerous changes. Dysplasia can be either low-grade, or high-grade depending upon how abnormal the changes are, with high-grade being the most abnormal.
Some people have no symptoms at all and the Barrett's oesophagus is discovered during tests for other medical conditions.
The most common symptom is ongoing heartburn and indigestion. Other symptoms include feelings of sickness (nausea), being sick (vomiting) and difficulty swallowing food. Less commonly, there may be blood in the vomit or stools (bowel motions). Some people have pain when swallowing food.
If you experience any of these problems for more than two weeks (or have a single episode of vomiting blood) it is advisable to visit your GP.
Your GP will examine you and may refer you to the hospital for a procedure known as an endoscopy to examine the lining of your oesophagus.
The endoscopy may be carried out by a by a doctor or specialist nurse, and enables the oesophagus to be examined using a thin flexible tube called an endoscope. Usually small samples of cells (biopsies) are taken, which can then be examined in a laboratory to see if they are normal.
You can usually have an endoscopy as an outpatient, but occasionally an overnight stay in hospital is necessary. You will be comfortably positioned on a couch. You may be given the choice of having a local anaesthetic spray to numb the back of your throat (and reduce any discomfort during the test); or a sedative to make you feel sleepy. The sedative is usually injected into a vein in the arm. The doctor or nurse then passes the endoscope down your oesophagus.
An endoscopy can be uncomfortable but it is not painful. After a few hours the effect of the sedative or anaesthetic will wear off and you'll be able to go home. You shouldn't drive for several hours after the test and, if possible, you should arrange for someone to travel home with you. The nurse or doctor will tell you how long to wait before you try to swallow anything. It may be around 1-2 hours afterwards. Some people have a sore throat following the procedure; this is normal and usually disappears after a couple of days. If it does not, it is advisable to contact your doctor at the hospital. You should also tell your doctor if you have any chest pain, breathlessness or blood in your vomit.
Often, people with Barrett's oesophagus are advised to have their condition checked at regular intervals in order to pick up any further changes. This is known as surveillance and usually involves regular endoscopies and biopsies. At present, it is not known how useful surveillance is. This is because of the small number of people with Barrett's oesophagus who actually go on to develop oesophageal cancer. It will be some time before the benefits and possible disadvantages of regular endoscopies become clear.
Depending on the degree of change in your condition, if any, and the policy at your hospital, the endoscopies may be repeated at intervals between 3 months and 3 years.
It may be helpful to discuss this with your specialist.
If you are having regular endoscopies and you notice any change or worsening of your symptoms between appointments, it is a good idea to contact your specialist.
Treatment is aimed at reducing the reflux and controlling symptoms.
Sometimes it is possible to reduce the reflux without treatment. Losing weight (if necessary), stopping smoking, or drinking less alcohol may help. Eating small meals at regular intervals, or avoiding foods that aggravate the symptoms, can also help to reduce reflux. If you suffer with reflux at night, it can help to raise the head of the bed.
You may be given medicines such as proton pump inhibitors (PPI), or histamine receptor blockers to decrease the production of stomach acid. This will help to reduce any symptoms that you have. Once the symptoms are controlled, the dose of your PPI may be reduced to a level that keeps the symptoms from recurring. PPIs are often taken for life, and are very safe to take long-term.
Surgery| can be carried out to help strengthen the valve at the bottom of the oesophagus, to prevent further acid reflux, or to remove the affected area.
Fundoplication This is an operation to strengthen the valve at the bottom of the oesophagus. During the operation, the top of the stomach (the fundus) is wrapped and stitched around the lower end of the oesophagus. This procedure reinforces (strengthens) the lower end of the oesophagus, and should help to reduce acid reflux. Fundoplication is often done using a laparoscope, which only involves small cuts in the abdomen. Less often it may involve a large incision in the abdomen (a laparotomy).
An operation to repair a hiatus hernia may also help to reduce acid reflux.
Removing the affected area If a biopsy shows that there are continuing changes in the cells lining the lower end of the oesophagus that may progress to cancer, your specialist may suggest that you consider having surgery to remove the affected area, or other treatments that can destroy the abnormal cells. Treatments to destroy these cells include photodynamic therapy and cold coagulation. Despite its name, cold coagulation uses heat (not cold) to destroy abnormal cells. A heated probe is placed near the affected area to get rid of the abnormal cells.
Endoscopic mucosal resection Sometimes, only the affected area of the lining of the oesophagus needs to be removed. This type of surgery is known as endoscopic mucosal resection . It is done via an endoscopy and can be done as a day case or sometimes with an overnight stay. This type of surgery may be followed by photodynamic therapy or endoscopic treatments.
More extensive surgery is sometimes needed. This involves removing the section of the oesophagus that contains the abnormal cells. The stomach is then joined to the remaining length of the oesophagus. After this operation, you are likely to spend a short period of time in the intensive care unit. You will have a drip put into a vein in your hand or arm until you are able to eat and drink again.
You may also have a fine tube (a nasogastric (NG) tube| ), inserted down your nose and into your stomach or small intestine to allow any fluids to be removed. This will stop you feeling sick and help the area of the operation to heal. You may feel afraid to swallow for a short time. You may also have a bad taste in your mouth. Mouthwashes can help to relieve this.
At first, you will probably be given only sips of liquid until your doctor is satisfied that the join in the oesophagus is healing. It will be a few days before you are able to drink normally. Gradually, you will also be able to eat normally again.
Some surgeons will also place a small feeding tube directly into the small bowel at the time of surgery, to feed you while you recover. This is usually removed after you have started to swallow normally.
There are some newer techniques that doctors are currently looking at. These include cold coagulation, argon plasma coagulation, radiofrequency ablation, multipolar electrocoagulation and endoscopic plication. Your specialist can tell you more about these treatments and whether any of them might be appropriate in your situation. It is important to remember that these techniques are not widely available and long-term data (research results) on their success is not yet available.
Photodynamic therapy is only done in specialist centres. Photodynamic therapy| uses laser light combined with a light-sensitive drug (sometimes called a photosensitising agent) to destroy the abnormal cells. Doctors are still researching how useful photodynamic therapy may be in treating Barrett's oesophagus. Your specialist can advise whether or not this treatment is appropriate in your situation.
It is often difficult to find information and support when you are diagnosed with a condition such as Barrett's oesophagus. You may have concerns about whether or not you need surveillance, medication, or perhaps an operation. It is important to discuss these concerns with the doctors and nurses caring for you.
You may have many different emotions| including anxiety and fear. These are all normal reactions, and are part of the process that many people go through in trying to come to terms with their condition. Many people find it helpful to talk things over with their doctor or nurse. Close friends and family members can also offer support.
This section has been compiled using information from a number of reliable sources including:
For further references, please see the general bibliography| .
Posted by Dianne J
Posted by lesley22
Posted by bob jk
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.
Browser does not support script.