In a recent presentation, dietitian Phoebe Wood from University College London Hospital (UCLH), outlined practical strategies to maintain nutritional health after treatment for Barrett’s oesophagus, manage swallowing difficulties, and support long-term oesophageal wellbeing. In this blog post, we provide an overview of her presentation.
Giving Your Body the Support It Needs
For people with Barrett’s oesophagus undergoing treatment, nutrition is not about following a special diet. The priorities are maintaining adequate nutrition, supporting healing, preventing unintentional weight loss and managing reflux symptoms in a way that works for you.
Good nutrition plays an important role in recovery following treatment for Barrett’s oesophagus. It can help to:
- Maintain strength and energy
- Support healing after procedures
- Reduce the risk of unintentional weight loss
- Preserve muscle mass
Understanding Barrett’s Oesophagus
Barrett’s oesophagus occurs when the lining of the oesophagus changes, usually as a result of long-term acid reflux or gastro-oesophageal reflux disease (GORD). It affects around 1–2% of the general population, rising to 8–13% among people with chronic reflux. Some people with Barrett’s oesophagus develop dysplasia (abnormal cell changes), which may require treatment to reduce the risk of progression to oesophageal cancer.
Treatment and Recovery
Common treatments include:
- Radiofrequency Ablation (RFA): Uses heat to remove abnormal cells.
- Endoscopic Mucosal Resection (EMR): Removes small areas of abnormal tissue.
- Endoscopic Submucosal Dissection (ESD): A similar technique to EMR that can be used to remove larger areas of abnormal tissue.
Following treatment, patients may experience symptoms such as sore throat, chest discomfort, painful swallowing, nausea, regurgitation, reduced appetite, and temporary swallowing difficulties (dysphagia). For most people, these symptoms improve gradually as healing occurs. The main nutritional goal during recovery is to maintain food and fluid intake while allowing the oesophagus to heal.
Eating After Treatment
Your treating team will provide specific instructions based on your procedure.
In general, eating progresses through stages:
- Day One: Cool liquids such as water, milk, pureed soups, and jelly.
- Early Recovery: Soft, easy-to-swallow foods including porridge, mashed potato, soft pasta dishes, cottage pie, cooked eggs, poached fish, and thoroughly cooked vegetables.
- Long-Term: Gradual return to a balanced diet based on the Eatwell Guide, as tolerated.
Managing Swallowing Difficulties
Temporary swallowing difficulties can occur after treatment due to inflammation and healing changes within the oesophagus.
Helpful strategies include:
- Taking smaller mouthfuls
- Eating slowly
- Chewing food thoroughly
- Choosing soft, moist foods
- Adding sauces, gravy or extra moisture to meals
- Utilising specialist, texture modified meal providers, such as Wiltshire Farm Foods and Oakhouse Foods
Foods often better tolerated include:
- Soft fish
- Eggs
- Yoghurt
- Cottage/soft cheese
- Tofu
- Soft casseroles
- Well-cooked vegetables
- Stewed or mashed fruit
If solid foods remain difficult, nourishing liquids such as soups, smoothies and milk-based drinks can provide valuable calories and protein.
Preventing Weight Loss and Malnutrition
Reduced food intake can lead to weight loss, reduced muscle strength and an increased risk of malnutrition.
Signs of malnutrition can include:
- Unintentional weight loss
- Clothing fitting more loosely
- Reduced strength
- Fatigue
If eating becomes difficult:
- Try eat little and often (aiming for 6-8 eating occasions per day)
- Choose full-fat foods where appropriate
- Prioritise protein at meals and snacks
- Add extra calories using full fat milk, cheese, cream, oils, spreads or nut butters
- Limit drinking large amounts of fluids within 30 minutes of meals to avoid feeling overly full.
- Consider shop bought nutritional drinks such as Complan, Meritene, YFood, BOL Power Shake, Huel, and Up & Go
- Consider nutritional supplement drinks if advised
Long-Term Reflux Management
There is no specific diet proven to treat or reverse Barrett’s oesophagus. However, managing reflux symptoms may help improve comfort and quality of life.
Many people find it helpful to:
- Eat smaller, more frequent meals.
- Avoid skipping meals or leaving long gaps between meals where possible
- Finish eating at least three hours before going to bed
- Eating slowly and chewing food thoroughly.
- Remain upright after meals
Common reflux triggers may include:
- Alcohol
- Citrus fruits
- Spicy foods
- Peppermint
- Coffee and caffeinated drinks
- Fried or fatty foods
- Chocolate
- Tomatoes
- Garlic and onions
- Carbonated drinks
Rather than eliminating multiple foods unnecessarily, consider testing one potential trigger at a time and monitoring symptoms.
Lifestyle Factors
Diet is only one part of managing Barrett’s oesophagus. Other factors associated with improved reflux control include:
- Maintaining a healthy weight
- Being physically active
- Stopping smoking
- Limiting alcohol intake
- Taking prescribed anti-reflux medication
When Should You Seek Help?
Speak with your healthcare team if you experience:
- Significant unintentional weight loss
- Ongoing swallowing difficulties
- Difficulty drinking enough fluids
- Persistent vomiting or regurgitation
- Symptoms that are worsening rather than improving
A referral to a dietitian may be helpful if you find it difficult to meet your nutritional needs.
Looking For More Information?
Download our Barrett’s oesophagus information leaflet for practical advice, answers to common questions and support to help you understand and manage your condition.
Disclaimer: These are the personal views of Phoebe, and not those of UCLH. The information provided is intended as general guidance and should not replace personalised advice from your healthcare team.
