NHS pilots non-invasive test for Barrett's esophagus as reflux cases rise in the UK

A non-invasive screening test for Barrett's esophagus is being piloted by the NHS to catch precancerous changes in people with chronic acid reflux, offering an alternative to endoscopy and potentially speeding up diagnosis for thousands who struggle with symptoms. The rollout comes as doctors and researchers emphasize that while most reflux cases are manageable, a small but significant share can lead to serious complications over time. In parallel, patient experiences illustrate how long-running reflux can affect quality of life and how testing and treatment pathways are evolving.

Paula Gresty, now 60, lives near Norwich and spent two decades living with acid reflux that struck four or five times a week after meals and at night. She describes the burning sensation as a fire in her stomach that would rise into her throat, sometimes forcing her to gasp for breath. Regurgitation followed later in her life, and she even recalls a day when she tripped, hit the basin and ended up with a black eye in the rush to reach the bathroom. Paula was diagnosed with reflux in her late 30s and was treated with a proton pump inhibitor (PPI) for many years, but her symptoms worsened over time.

In 2021 she was found to have a hiatus hernia, and by 2022 an endoscopy confirmed both gastro-oesophageal reflux disease (GORD) and Barrett's esophagus. Her journey underscores the dual challenge of persistent symptoms and the risk of longer-term complications, including cancer. Experts warn that the longer reflux persists, the greater the chance of damage to the esophageal lining, ulcers and bleeding. Paula notes that after her 2022 finding, she was offered lifestyle guidance and weight loss strategies, but no immediate surgical option. By 2024 she had difficulty swallowing, prompting a second endoscopy and ongoing biopsies while she awaits a final surgical plan. "I wish I had pressed my GP for more follow-up years ago," she says. "Pressing for more follow-up saved me time and worry later."

The Cytosponge test, described by researchers as the gold-standard endoscopy alternative for Barrett's screening, is a capsule attached to a string that dissolves in the stomach, releasing a small sponge. The sponge collects cells as it is pulled back up, enabling lab analysis for Barrett's changes. Professor Rebecca Fitzgerald, who helped develop the test, says the goal is to make testing more accessible outside specialist units and to catch cancer precursors earlier. The NHS announced a pilot heartburn health check in July that will offer the Cytosponge to about 1,500 people in London and the east Midlands who regularly use heartburn medicines, whether over the counter or prescription. "We eventually hope it will be widely available in community settings, such as shopping centres, to reach people who never visit their GP," Fitzgerald says. "Currently too many people with persistent heartburn aren't tested and just put up with things. Most won't get cancer, but for the minority that do, we often see it too late."

The condition affects millions: there are about eight million people in the UK with acid reflux, and studies place those with regular reflux at more than 5.5 million Britons, roughly one in ten. Yet many people self-medicate and go untreated, making the exact number uncertain. While lifestyle changes can ease symptoms, many patients rely on PPIs as first-line therapy to reduce stomach acid. However, PPIs are not a cure-all. About 18 percent of patients continue to experience reflux despite treatment, which may reflect non-acid reflux, misdiagnosis, or diminished medication effectiveness over time. In addition, PPIs have been linked in some studies to changes in the gut microbiome, raising questions about long-term use.

Doctors emphasize that not every heartburn case is reflux, and chest pain can mimic a heart attack, so persistent symptoms warrant medical evaluation. Alongside PPIs, antacids and alginates are commonly used to relieve symptoms by neutralizing acid or coating the esophagus. Still, some patients experience side effects or require alternative strategies if symptoms persist.

For those whose symptoms resist medication, surgical options exist. Fundoplication, the most common anti-reflux surgery, strengthens the valve at the lower end of the esophagus by wrapping part of the stomach around it. It is typically performed as a keyhole procedure and boasts an 80–90 percent success rate in reducing reflux symptoms, though side effects can include gas-related pain, bloating and swallowing issues. The LINX procedure offers a less invasive approach by placing a ring of magnetic beads around the valve to reinforce it; swallowing temporarily pushes beads apart, then they reclose to prevent reflux. While LINX has high success rates, it may not be suitable for patients with pre-existing swallowing difficulties and can carry costs around £10,000 to £12,000. A newer option, RefluxStop, inserts a small silicone device at the top of the stomach to help keep the valve closed without compressing the esophagus; currently available in a limited number of NHS hospitals and private settings with higher cost.

Despite advances, experts stress that testing remains crucial. Barrett's esophagus itself carries a relatively low risk of progression to cancer, but when cancer develops, it is a deadly disease responsible for thousands of deaths annually in the United Kingdom. The minority who progress often require intensive monitoring and treatment. Early detection through reliable testing could improve outcomes, particularly for patients who do not regularly visit their GP. The Cytosponge test is not yet universal, but health authorities hope it will become a mainstream option, enabling earlier identification of Barrett's and timely intervention.

Paula’s story, while personal, reflects broader themes in health care: the need for greater awareness of reflux symptoms, the importance of proper testing, and the potential of new technologies to change how conditions like Barrett's esophagus are diagnosed and managed. Her case also highlights the human side of chronic conditions—the impact on daily life, the sense of relief with a possible treatment path, and the ongoing uncertainty that can follow years of symptoms. As she awaits biopsy results and a final surgical plan, Paula advises others to seek follow-up care rather than soldier on with persistent symptoms, noting, "If you’ve had reflux for years, don’t wait. Ask for a second opinion or a referral; better to know now than to guess later." Health officials say the hope is that a combination of better testing, patient education and timely interventions will reduce the burden of reflux and its potential complications in the years ahead.

Health systems continue to evaluate how best to integrate new screening tools with existing care pathways. In the meantime, physicians urge patients with persistent reflux symptoms, especially those accompanied by regurgitation, a persistent sore throat, hoarseness or coughing, to seek evaluation. Keeping a symptom diary, identifying triggers, maintaining a healthy weight, avoiding late meals, and elevating the head of the bed can help reduce nighttime symptoms. For many, a combination of lifestyle adjustments and medication offers relief, but those with ongoing symptoms or new swallowing difficulties should pursue escalation of care to rule out Barrett's esophagus or other complications. The overarching goal is to catch and treat problems early, preventing progression and improving quality of life for people living with acid reflux and its sometimes life-changing consequences.