Treatments

Press Release by American Gastroenterology Society

Watchful waiting no longer recommended for some high-risk Barrett’s esophagus patients

Treatments for Barrett’s Oesophagus
Most treatments for Barrett’s Oesophagus aim to reduce the acid and bile reflux and control symptoms.

What you can do

    • If your heartburn is worse at night, avoid eating large meals in the evening. Raise the head of your bed so that your head is higher than your stomach.
    • If you are a smoker, quit.
    • Reduce or cut out alcohol and caffeine.
    • Avoid foods that you know trigger your heartburn, for example, fatty foods, chocolate, citrus fruit, spicy foods.
    • If you are overweight, try to lose weight.

Drug treatment
You will usually be given tablets to lower the acid content of your stomach. The most common are called proton pump inhibitors. They will control the heartburn and should stop your oesophagus becoming inflamed. You will probably need to take these tablets permanently.

If your symptoms are worse at night you may be given an acid suppressor like ranitidine (Zantac).

Surgical treatment
You may have surgery recommended to strengthen the weak valve at the lower end of your oesophagus, especially if you suffer from bile backing up, which is less easy to control with tablets.

This surgery is called a Fundoplication and can be done as a keyhole (laparoscopic) procedure. This usually stops the reflux of acid or bile.

However, as with all operations, there are benefits and risks and this treatment is not recommended for everyone It is important to discuss the options with your surgeon.

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Regular check-ups
If you have been diagnosed with Barrett’s Oesophagus regular check-ups will be recommended to have both an endoscopy and a biopsy. How often you have these check-ups will depend; your doctors may want to see you several times a year, or may feel that every two years is sufficient. These regular checks will allow them to monitor any changes in the cells of your oesophagus and to alter your treatment as necessary.

Treatments to prevent cancer
Since the vast majority of patients with Barrett’s Oesophagus do not get cancer, the usual practice is not to attempt to remove the Barrett’s cells. Treatment is usually only offered if the cells look as if they are starting to change in a way that suggests a worsening of the condition. These cellular changes are called dysplasia.

What happens if dysplasia is found?
If the pre-cancerous cell changes are detected within the Barrett’s lining, the endoscopy and tissue sampling are repeated more frequently – generally six-monthly for low grade dysplasia or three-monthly if high grade dysplasia is found.

If the endoscopy and tissue sampling show high grade dysplasia, and particularly if it is found in several of the biopsies, then treatment is recommended. High grade dysplasia is strongly associated with cancer of the gullet and early treatment can potentially prevent the risk of cancer.

All people with high grade dysplasia should be referred to a specialist centre where their case is discussed by a multi-disciplinary team of doctors . All treatments will aim to remove the dysplasia.

Some experts believe that patients should have an operation to remove the gullet, called an oesophagectomy. Others believe that surveillance through endoscopies at regular intervals is sufficient and that an operation should be reserved for patients who have developed cancer.

An oesophagectomy is major surgery and usually involves opening both the stomach and the chest. It takes some months for people to return to full health. Surgery is therefore not generally recommended for patients with declining health or for those who are too weak to withstand a major procedure.

Alternative treatments involve removing the abnormal Barrett’s lining during an endoscopy. Procedures include:

Epithelial Radio Frequency Ablation for Barrett’s Oesophagus
An electric wire is inserted into the oesophagus and burns away dysplasia.The
Barrx RF Ablation System uses this technique for treating Barrett's Oesophagus.

Photodynamic therapy (PDT)
A drug is given to make the Barrett’s cells sensitive to light. A light is then inserted into the oesophagus and burns off the Barrett’s tissue.

Endoscopic Mucosal Resection (EMR)
If only a small area of the Barrett’s lining is affected by dysplasia this may be removed by a suction and snare procedure performed during an endoscopy. In this, suction is used to lift the Barrett’s tissue off the wall of the oesophagus. A wire snare is passed down the endoscope, looped over the tissue and tightened. The snare is then heated, which releases the tissue and seals blood vessels to minimise bleeding (electrocoagulation).

Laser therapy. Barrett’s cells are destroyed by a laser probe inserted in the oesophagus. This is effective but difficult to apply evenly.

Argon plasma coagulation. A jet of argon gas is released into the gullet along with an electric current that burns away dysplasia.

These procedures are usually combined with strong doses of acid lowering tablets, also called proton pump inhibitors, to try to ensure that the abnormal lining does not regrow.

For more about treatments and managing your condition, download theTreatments for Barrett’s Oesophagus leaflet (PDF, 876kb).

To request printed information leaflets, call 020 7472 6223 or email info@barrettscampaign.org.uk