diff --git a/.gitignore b/.gitignore
index 8441e5a64..47b0bed4e 100644
--- a/.gitignore
+++ b/.gitignore
@@ -6,3 +6,4 @@ dist/
 htmlcov/
 .tox/
 docs/_build/
+.venv
diff --git a/CHANGES.rst b/CHANGES.rst
index 493cf2d88..5ff98fb27 100644
--- a/CHANGES.rst
+++ b/CHANGES.rst
@@ -5,6 +5,8 @@ Version 8.3.x
 
 Unreleased
 
+-   Fix Fish shell completion errors when option help text contains newlines.
+    :issue:`3043`
 -   Don't discard pager arguments by correctly using ``subprocess.Popen``. :issue:`3039`
     :pr:`3055`
 -   Replace ``Sentinel.UNSET`` default values by ``None`` as they're passed through
diff --git a/src/click/shell_completion.py b/src/click/shell_completion.py
index 8f1564c49..b574f4b69 100644
--- a/src/click/shell_completion.py
+++ b/src/click/shell_completion.py
@@ -180,14 +180,18 @@ def __getattr__(self, name: str) -> t.Any:
 COMP_CWORD=(commandline -t) %(prog_name)s);
 
     for completion in $response;
-        set -l metadata (string split "," $completion);
+        set -l metadata (string split \n $completion);
 
         if test $metadata[1] = "dir";
             __fish_complete_directories $metadata[2];
         else if test $metadata[1] = "file";
             __fish_complete_path $metadata[2];
         else if test $metadata[1] = "plain";
-            echo $metadata[2];
+            if test $metadata[3] != "_";
+                echo $metadata[2]\t$metadata[3];
+            else;
+                echo $metadata[2];
+            end;
         end;
     end;
 end;
@@ -417,10 +421,19 @@ def get_completion_args(self) -> tuple[list[str], str]:
         return args, incomplete
 
     def format_completion(self, item: CompletionItem) -> str:
-        if item.help:
-            return f"{item.type},{item.value}\t{item.help}"
+        """Format completion item for Fish shell.
 
-        return f"{item.type},{item.value}"
+        Escapes newlines in both value and help text to prevent
+        Fish shell parsing errors.
+
+        .. versionchanged:: 8.3
+            Escape newlines in help text to fix completion errors
+            with multi-line help strings.
+        """
+        help_ = item.help or "_"
+        value = item.value.replace("\n", r"\n")
+        help_escaped = help_.replace("\n", r"\n")
+        return f"{item.type}\n{value}\n{help_escaped}"
 
 
 ShellCompleteType = t.TypeVar("ShellCompleteType", bound="type[ShellComplete]")
diff --git a/tests/test_shell_completion.py b/tests/test_shell_completion.py
index 20cff238f..492231ea9 100644
--- a/tests/test_shell_completion.py
+++ b/tests/test_shell_completion.py
@@ -357,9 +357,9 @@ def test_full_source(runner, shell):
         ("bash", {"COMP_WORDS": "a b", "COMP_CWORD": "1"}, "plain,b\n"),
         ("zsh", {"COMP_WORDS": "", "COMP_CWORD": "0"}, "plain\na\n_\nplain\nb\nbee\n"),
         ("zsh", {"COMP_WORDS": "a b", "COMP_CWORD": "1"}, "plain\nb\nbee\n"),
-        ("fish", {"COMP_WORDS": "", "COMP_CWORD": ""}, "plain,a\nplain,b\tbee\n"),
-        ("fish", {"COMP_WORDS": "a b", "COMP_CWORD": "b"}, "plain,b\tbee\n"),
-        ("fish", {"COMP_WORDS": 'a "b', "COMP_CWORD": '"b'}, "plain,b\tbee\n"),
+        ("fish", {"COMP_WORDS": "", "COMP_CWORD": ""}, "plain\na\n_\nplain\nb\nbee\n"),
+        ("fish", {"COMP_WORDS": "a b", "COMP_CWORD": "b"}, "plain\nb\nbee\n"),
+        ("fish", {"COMP_WORDS": 'a "b', "COMP_CWORD": '"b'}, "plain\nb\nbee\n"),
     ],
 )
 @pytest.mark.usefixtures("_patch_for_completion")
@@ -559,3 +559,50 @@ def cli(ctx, config_file):
             assert not current_warnings, "There should be no warnings to start"
             _get_completions(cli, args=[], incomplete="")
             assert not current_warnings, "There should be no warnings after either"
+
+
+@pytest.mark.usefixtures("_patch_for_completion")
+def test_fish_multiline_help_complete(runner):
+    """Test Fish completion with multi-line help text doesn't cause errors."""
+    cli = Command(
+        "cli",
+        params=[
+            Option(
+                ["--at", "--attachment-type"],
+                type=(str, str),
+                multiple=True,
+                help=(
+                    "\b\nAttachment with explicit mimetype,\n--at image.jpg image/jpeg"
+                ),
+            ),
+            Option(["--other"], help="Normal help"),
+        ],
+    )
+
+    result = runner.invoke(
+        cli,
+        env={
+            "COMP_WORDS": "cli --",
+            "COMP_CWORD": "--",
+            "_CLI_COMPLETE": "fish_complete",
+        },
+    )
+
+    # Should not fail
+    assert result.exit_code == 0
+
+    # Output should contain escaped newlines, not literal newlines
+    # Fish expects: plain\n--at\n{help_with_\\n}
+    lines = result.output.split("\n")
+
+    # Find the --at completion block (3 lines: type, value, help)
+    for i in range(0, len(lines) - 2, 3):
+        if lines[i] == "plain" and lines[i + 1] in ("--at", "--attachment-type"):
+            help_line = lines[i + 2]
+            # Help should have escaped newlines (\\n), not actual newlines
+            assert "\\n" in help_line
+            # Should contain the example text
+            assert "image.jpg" in help_line.replace("\\n", " ")
+            break
+    else:
+        pytest.fail("--at completion not found in output")