Requires Endoscopic Surveillance:
If patient has less than 1cm of Barrett’s oesophagus then no biopsies and no follow up required.
For
those with Histologically proven Barrett’s oesophagus greater than or
equal to 1cm length, follow up interval depends on presence of
dyplasia and length of Barrett’s segment*
* follow-up by cytosponge with endoscopy for selected cases.
Do not routinely offer OGD to those with GORD to diagnose Barrett’s especially if <age 50
Consider referral if long standing GORD especially if
- Age 50 years or older
- long duration of symptoms
- worsening symptoms
- male
- previous hiatus hernia or oesophagitis
- obesity (BMI>30)
- family history of Barrett’s or oesophageal adenocarcinoma
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 less than 1cm of Barrett’s oesophagus then no biopsies and no follow up required
- After diagnosis, endoscopic follow up interval depends on
- presence of dysplasia and
- length of Barrett’s segment
- If dysplasia is absent OGD, next follow-up should be 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 every 3 years*
All others
- OGD every 5 years
*Follow-up currently by cytosponge with endoscopy for selected cases
If there is doubt about presence of dysplasia OGD is repeated after 6 months (usually with increased PPI dose)
If Low grade dysplasia (LGD) is present OGD is repeated every 6 months until either
If high grade dysplasia (HGD) is present – urgent referral to GI services at RIE
