Treatment

These pages deal with the treatment of the possible consequential problems from acid and bile reflux, Barrett's Oesophagus and Oesophageal Adenocarcinoma (cancer).

For treatments to prevent reflux see the chapter on Reflux reduction techniques - medication, surgery and devices.

Because the risks of progression to cancer of "normal", non-dysplastic, Barrett's are very small (see the page on Barrett's Oesophagus), the best advice is usually to leave it as it is but to receive regular surveillance every few years.

Guidelines issued in 2013 by the British Society for Gastroenterology [tr-i], included this map for surveillance of non-dysplastic Barrett's:

"Columnar lined oesophagus" indicates the cellular changes we know as Barrett's.

"OGD" (= Oesophago-Gastro-Duodenoscopy) is the term for the type of surveillance endoscopy used looking at the oesophagus, stomach and duodenum.

"Squamous epithelium" is the normal lining of the oesophagus.

"Glandular metaplasia" indicates a change in cell structure = Barrett's Oesophagus.

"Gastric metaplasia" indicates the changed cells resemble those found in the stomach.

"Intestinal metaplasia" indicates the changed cells resemble those found in the intestines.

If short segment Barrett's is identified (i.e. less than 3 cm in length), it is recommended surveillance scoping be carried out every 3 to 5 years.

For segments of 3 cm or longer, a surveillance interval of 2 to 3 years is recommended.

However, there is a growing number of gastroenterologists who question the value of regular surveillance, since for the vast majority of those with non-dysplastic Barrett's it will never progress, suggesting it better to attempt to identify those particularly at risk of progression to receive endoscopy.

If dysplasia is discovered, the following map for surveillance is shown in the 2017 revised guidelines [tr-ii]: