Carlos, aged 48, always believed that heartburn was part of his routine. After meals, particularly at night, he experienced intense burning in his chest, a bitter taste in his mouth, and a sensation of food coming back up through his throat. Over time, he began to notice difficulty swallowing certain foods and frequent episodes of dry cough during the early morning hours.

Like many people, he tried to relieve his symptoms only with occasional dietary changes and over-the-counter medications. However, after years of living with frequent reflux, he decided to seek medical evaluation. During the investigation, he underwent an upper endoscopy and received a diagnosis of Barrett's Oesophagus.

This is a condition that deserves attention because it is related to changes in the oesophageal cells caused by continuous exposure to stomach acid.

What is Barrett's Oesophagus?

Barrett's Oesophagus is an alteration in the internal lining of the oesophagus, usually caused by chronic gastro-oesophageal reflux. In this condition, the normal cells of the oesophagus undergo transformation due to constant irritation caused by gastric acid.

Although not everyone with reflux develops Barrett's Oesophagus, the risk increases when symptoms persist for many years without adequate treatment.

The main concern related to Barrett's is that, in some cases, it can increase the risk of developing oesophageal cancer, especially oesophageal adenocarcinoma.

Main symptoms

Many people do not present specific symptoms of Barrett's Oesophagus itself, but usually have signs related to gastro-oesophageal reflux, such as:

  • Frequent heartburn

  • Burning sensation in the chest

  • Sensation of food reflux

  • Bitter taste in the mouth

  • Pain or discomfort after meals

  • Persistent dry cough

  • Frequent hoarseness

  • Difficulty swallowing

  • Sensation of food stuck in the throat

In some cases, symptoms may decrease over time, even with disease progression, which leads many people to believe there has been spontaneous improvement.

Main causes

The main cause of Barrett's Oesophagus is chronic gastro-oesophageal reflux. Repetitive contact of stomach acid with the oesophagus causes continuous injury to the oesophageal mucosa.

Other factors can also contribute to the development of the condition:

  • Hiatal hernia

  • Obesity, particularly abdominal obesity

  • Smoking

  • Excessive alcohol consumption

  • Diet rich in fatty and ultra-processed foods

  • Prolonged history of reflux

  • Male sex

  • Age over 50 years

  • Family history of Barrett's or oesophageal cancer

Risk factors that deserve attention

Some situations significantly increase the risk of developing Barrett's Oesophagus:

  • Reflux for more than 5 years

  • Frequent heartburn symptoms, particularly at night

  • Excess weight

  • Sedentary lifestyle

  • Chronic smoking

  • Inadequate diet

  • Presence of hiatal hernia

People with persistent reflux should seek medical evaluation, especially when symptoms become frequent or begin to interfere with quality of life.

How is the diagnosis made?

The main examination used for diagnosis is upper endoscopy.

During the examination, the doctor observes alterations in the oesophageal mucosa and, when necessary, performs biopsies for microscopic analysis of the cells.

The biopsy is fundamental because it helps identify whether there are cellular alterations called dysplasia, which may indicate a greater risk of progression to cancer.

In some cases, periodic follow-up with new endoscopies may be necessary to monitor disease progression.

What is the treatment?

Treatment of Barrett's Oesophagus depends on the degree of alteration found on the examinations.

The main objectives are to control the reflux, reduce inflammation, and monitor possible cellular changes.

The approaches may include:

Lifestyle changes

  • Weight loss

  • Avoiding large meals before sleep

  • Reducing fatty and highly acidic foods

  • Stopping smoking

  • Reducing alcohol consumption

  • Elevating the head of the bed

  • Improving eating habits

Pharmacological treatment

The most commonly used medications are proton pump inhibitors, which help reduce acid production in the stomach and control reflux.

Endoscopic treatments

When there are important cellular alterations, specific procedures performed by endoscopy may be indicated to remove or destroy the altered areas.

Surgery

In some patients, particularly in cases associated with significant hiatal hernia or severe reflux that is difficult to control, anti-reflux surgery may be considered.

The importance of follow-up

Barrett's Oesophagus does not necessarily mean cancer. However, it is a condition that requires adequate follow-up, particularly when cellular alterations are identified on biopsy.

Early diagnosis and correct treatment help reduce complications and significantly improve the patient's quality of life.

Ignoring persistent reflux symptoms can delay important diagnoses.

Final message

Experiencing heartburn occasionally can happen, but frequent reflux should not be considered normal. Persistent symptoms deserve appropriate medical investigation.

This content is informational and educational in nature only. It does not replace medical consultation, professional evaluation, or the performance of examinations. In case of symptoms or concerns, seek follow-up with a doctor.

Dr. Rebeca Soares Andrade CRM-GO 39335