Barrett's oesophagus - treatments
Medical (non-surgical) therapy
The medical treatments for the symptoms of Barrett's oesophagus are the same as those for gastro-oesophageal reflux disease or GORD.
The suppression of acid is the backbone of treatment for GORD. For milder reflux symptoms over-the-counter medications are commonly used, ranging from antacids to low doses of the class of medicines called H-2 receptor antagonists (or H2 blockers) and of proton pump inhibitors (PPIs).
For more persistent symptoms requiring maintenance (ongoing) therapy or for complicated GORD with strictures or bleeding, then prescription proton pump inhibitors (PPIs) are used.
PPIs are potent inhibitors of the secretion of acid from the stomach. They are effective in relieving heartburn and healing oesophageal inflammation ( oesophagitis) and oesophageal ulcers that are induced by acid reflux. The PPIs are well tolerated with few side effects.
A number of drugs including tricyclic antidepressants and calcium channel blockers may promote gastro-oesophageal reflux. If an alternative medication can be substituted for these medications, this may help in the management of the reflux. Patients with GORD should ask their doctors whether they are taking medications that can promote reflux and if alternatives are available.
Adjunctive (supplementary) medication therapy has been used in the past for patients whose symptoms are not easily controlled. The supplementary medications have usually fallen into the class called prokinetics. These drugs work by accelerating gastric emptying so that there is less food and fluid available in the stomach to reflux.
In addition to medication therapy certain lifestyle measures are very important. These include:
- Lose weight, if overweight.
- Change diet by reducing fat, chocolate, caffeine and acid food and fluids (such as citrus).
- Stop smoking.
- Avoid excessive alcohol.
- Avoid food and fluids for two to three hours before going to bed.
- Elevate your upper body when lying in bed by 15cm (6in) by putting blocks under the bed's feet at its head.
Surgical treatment of GORD, with or without Barrett's oesophagus
GORD, with or without the presence of Barrett's oesophagus, sometimes is treated by anti-reflux surgery. One of the most common surgical techniques is called fundoplication. The operation involves wrapping the upper stomach (the fundus) around the lower end of the oesophagus. The purpose of the wrap is to tighten up the lower oesophageal sphincter (LOS valve) that is intended to prevent the reflux of stomach contents into the oesophagus.
Candidates for the fundoplication operation include patients with GORD who:
- Have developed serious complications such as persistent strictures
- Have symptoms despite appropriate medical treatment
- Require high doses of acid suppressing medications on an ongoing basis, and want to come off these medications.
Today this surgery is usually done laparoscopically without the need for a large incision. Patients can be discharged from hospital within a few days with a much shorter recovery time. With laparoscopy, the operative field is visualised and the fundoplication accomplished through several small holes made in the abdomen. However, for technical reasons the laparoscopic type of surgery cannot be done in some patients, and the conventional open operation is necessary.
A number of new endoscopic approaches are being evaluated to possibly replace surgery (fundoplication) for the treatment of GORD. The idea is to endoscopically tighten up the junction between the stomach and oesophagus to prevent reflux. The tightening is done during upper GI endoscopy by, for example, internally sewing (suturing) or clipping the region of the lower oesophageal sphincter.