The Treatment
Barrett’s syndrome (Barrett’s esophagus) is the occurrence of a specialized intestinal metaplasia in the esophagus, in the context of Gastroesophageal Regression. The appearance of intestinal metaplasia in the heart (upper part) of the stomach is also considered by many to be in the same category.
Intestinal metaplasia in the oesophagus, like intestinal metaplasia in the stomach, is considered a condition that may develop into adenocarcinoma (of the oesophagus or stomach respectively).
Barrett’s is thought to be the result of chronic reflux disease, although the full context of the disease is not clear today. There are young people who develop Barrett’s and on the other hand there are elderly patients with chronic and severe reflux who will never develop Barrett’s. Apparently genetic and other factors that remain to be determined are involved in the development of the disease.
The likelihood of Barrett’s progressing to cancer depends both on the extent of the lesion in the individual patient and on other factors. Men are typically ten times more likely than women to progress.
The treatment of Gastroesophageal Regression and Barrett’s in particular currently consists of lifestyle and dietary modifications (lifestyle modifications); and treatment with drugs of the PPI (proton pump inhibitors) class on the grounds that the reduction of acid in the stomach → reduction of reflux, combined with monitoring (many today question the treatment with PPI’s and even the necessity of frequent monitoring)
The treatment regimen is:
1. PPI: 1 pill x 2 times a day (30 minutes before breakfast and 30 minutes before an afternoon snack).
2.Tabl Maalox plus: 1 tablet x 3 times a day (1 hour after meals) or other antacids (such as alginate agents) in special cases.
In difficult cases the regimen is modified or invasive treatment is considered:
– Barrett’s follow-up currently is gastroscopy with biopsies every year.
– In case of mild dysplasia or atypia, the gastroscopy is repeated at three months (to exclude the possibility of more severe dysplasia).
– If mild dysplasia is confirmed, either invasive treatment or continuation with 6-monthly follow-up is currently considered acceptable.
– In cases of more severe dysplasia we intervene invasively (endoscopic resection of Barrett’s, destruction with radio waves or Argon, surgical treatment).
– In cases of Barrett’s of small extent where the invasive treatment is of low risk of complications, today it is considered legitimate to perform invasive treatment even in the absence of dysplastic lesions.
Endoscopy units
