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Treatment for Barrett’s oesophagus

Find out about treatment for Barrett’s oesophagus, including medicines to stop stomach acid, light treatment and surgery.

Barrett’s oesophagus means that some cells in the lining of your food pipe have started to change. In a small number of people these cells may develop into oesophageal cancer over a long period of time.

The cells lining the food pipe are normally flat. They’re called squamous cells. In Barrett's oesophagus they change into a type more like the columnar (column shaped) cells in the lining of the small and large bowel.

The cells may grow abnormally. Doctors call this dysplasia. The dysplasia can be low grade or high grade. The grade means how abnormal the cells look under a microscope. The more abnormal they look, the higher the grade.

Some treatments aim to control symptoms and reduce the risk of the abnormal cells developing into cancer. They lower the amount of acid the stomach produces.

Other treatments remove the damaged areas in the lining of the food pipe.

Medicines to reduce stomach acid

These medicines aim to control the symptoms of indigestion and heartburn. They include drugs called proton pump inhibitors, eg. omeprazole tablets.

You may need to keep taking these tablets as long as they control your symptoms. But you may be able to reduce the dose after a while.

Treatments by endoscopy

You have some treatments to get rid of the abnormal cells through a flexible tube called an endoscope put into your food pipe. You can have different types of treatment through the endoscope.

Removing the abnormal cells (endoscopic surgery)

Your doctor can remove abnormal areas or outgrowths from the lining of the food pipe or the stomach. They use a thin wire called a snare put down through the endoscope to remove the inner lining of the oesophagus. This operation is called endoscopic mucosal resection or an EMR.

Your doctor uses a long flexible tube (endoscope) with a tiny camera and light on the end to look inside your oesophagus. Then they remove the abnormal area by passing special instruments through the tube.

Radiowave treatment (radiofrequency ablation)

Radiofrequency ablation (RFA) uses heat made by radiowaves to kill cancer cells. It is also called radiowave treatment.

Your doctor puts a probe down the endoscope. The probe creates an electrical current which heats the cancer cells to high temperatures and destroys them.

You may have this treatment on its own or you may have RFA after endoscopic surgery to destroy any remaining abnormal cells in the area.

Light treatment (photodynamic therapy)

Photodynamic therapy is also called PDT. You have a drug that makes the abnormal cells sensitive to light. Then your doctor shines a light at the abnormal area through an endoscope. The light activates the drug to kill the cells.

Freezing treatment (cryotherapy)

Cryotherapy means destroying tissue by freezing it. Your doctor puts a small tube into your throat. They use liquid nitrogen to freeze the area containing the abnormal cells. The damaged cells fall off, so normal cells can replace them.

Surgery

You might need surgery if medicines aren’t controlling your symptoms and you have indigestion and heartburn.

Strengthening the food pipe valve

A surgeon can sometimes strengthen the valve at the lower end of your oesophagus. This is a small operation called fundoplication.

It stops acid from the stomach going back up into the oesophagus and reduces indigestion and heartburn.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Reducing cancer risk

05 May 2016
  • Guidelines on the Diagnosis and Management of Barrett's Oesophagus, RC Fitzgerald, M di Pietro, K Ragunath K and others. Gut. October 2013

  • Treatment for Barrett's oesophagus. JR Rees, P Lao-Sirieix P, A Wong A, RC Fitzgerald. Cochrane Database Systematic Review. Jan 2010.

  • Cancer and its management (6th edition). Tobias J and Hochhauser D. Wiley-Blackwell, 2010.

  • Diagnosis and management of Barrett's oesophagus. J Janowski, K Wang, B Delaney. British Medical Journal, 2010.

  • Endoscopic radiofrequency ablation for Barrett's oesophagus with low‑grade dysplasia or no dysplasia, NICE interventional procedure guidance.NICE guidance, May 2010.

  • Barrett's oesophagus overview. National Institute for Health and Care Excellence - http://pathways.nice.org.uk/ pathways/barretts-oesophagus

  • Barrett's oesophagus: ablative therapy, NICE guidelines, 2010.

  • Photodynamic therapy for Barrett's oesophagus, NICE guidance, June 2010.

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