Management of Barrett oesophagus

Therapy for Barrett oesophagus aims to control symptoms and reduce the risk of complications, including malignancyWhiteman, 2015. Proton pump inhibitor (PPI) therapy is effective for oesophagitis and reflux symptoms in patients with Barrett oesophagus (see Management of frequent or severe symptoms of gastro-oesophageal reflux disease (GORD) in adults for PPI dosage regimens and other details).

There is some evidence that combination therapy with a high-dose PPI and aspirin reduces the rate of adenocarcinoma in patients with Barrett oesophagus. However, this should only be used after consultation with a specialist as endoscopic surveillance is still required.

Fundoplication does not reduce the risk of adenocarcinoma in patients with Barrett oesophagus.

In selected patients with confirmed dysplasia or superficial carcinoma, the rate of development of adenocarcinoma is reduced by endoscopic resection of nodular areas followed by ablation of the remaining Barrett mucosa, and ongoing PPI therapyWhiteman, 2015.