Requires Surveillance:
If patient has <1cm of Barrett’s oesophagus then no biopsies and no follow up required.
For those with histologically proven Barrett’s oesophagus ≥1cm length, follow up interval depends on presence of dysplasia and length of Barrett’s segment*
* Follow-up by oesophageal cell collection device ( “Cytosponge”), with endoscopy for selected cases.
Do not routinely offer OGD to those with GORD to diagnose Barrett’s especially if age <55
Consider referral if long standing GORD especially if
- family history of Barrett’s or oesophageal adenocarcinoma
- Age 55 years or older
- long duration of symptoms
- worsening symptoms
- male
- previous hiatus hernia or oesophagitis
- obesity (BMI>30)
- smoker
Barrett’s oesophagus Treatment
- Offer long term maintenance full dose PPI (eg omeprazole 20mg daily)
- Remain on full dose PPI (high dose may be necessary to control symptoms)
- High dose PPI (eg omeprazole 40mg daily)
- Switch to another PPI at full or high dose if initial PPI fails to control symptoms
Follow up of Barrett’s oesophagus (NHS Lothian)**
- If patient has < 1cm of Barrett’s oesophagus, then no biopsies and no follow up required
- After diagnosis follow up interval depends on:
- presence of dysplasia and length of Barrett’s segment
- If dysplasia is absent at index OGD, next follow-up should be by Cytosponge, repeated in 1 year
- If dysplasia is absent at 1year, subsequent follow up interval depends on length of Barrett’s segment.
Barrett’s >3cm
- OGD or Cytosponge every 3 years**
All others
- OGD or Cytosponge every 5 years**
**Follow-up currently by Cytosponge, with endoscopy for selected cases
Further Information
The presence of low- or high-grade dysplasia will usually lead to MDT referral and/or endoscopic therapy: this will be sorted in secondary care once histology results available
If there is doubt about presence of dysplasia OGD is repeated after 6 months (usually with increased PPI dose)
