This leaflet describes the various ways in which
Barrett's Oesophagus is treated. There are two aimsin treating Barrett's Oesophagus: to relieve the
symptoms of acid reflux and to prevent it developinginto cancer.
Treatment of acid reflux
soon as you get symptoms.
People with Barrett's Oesophagus
Rennies and Tums, and most of
often have bad acid reflux but,
the other medicines which you
curiously, may have very few
can buy over the counter, work in
symptoms. The treatment for
reflux in people with Barrett's
Alginates also contain antacids
Oesophagus is the same as for
but, in addition, have a special
people who do not have Barrett's.
ingredient which coats the lining
There are three approaches:
of the stomach and oesophagus.
This barrier prevents the acid
1. Things you can do for yourself
from breaching the area where it
avoid eating large meals and
would otherwise cause damage.
avoid eating within two hours
Gaviscon and Gastrocote are
of going to bed.
examples of this class of medicine.
The following foods tend to
make reflux symptoms worse:
Acid suppression tablets work to
chocolate, coffee, alcohol, fizzy
stop acid being made before it can
drinks, spicy foods, citrus.
cause damage. There are two types: histamine receptor
However, lifestyle changes will
antagonists like ranitidine (Zantac)
only help about one in five who
and proton pump inhibitors (PPIs)
have the condition.
such as omeprazole, lansoprazole, pantoprazole, rabeprazole and
esomeprazole. These PPIs are far
Antacids immediately neutralise
more effective at controlling acid
the acid that has already been
reflux. Most patients with Barrett's
made. They may be either liquids
Oesophagus will be taking one of
or tablets and should be taken as
working to prevent cancer of the gullet
severe symptoms should consider
Fundoplication surgery is a
taking acid suppression tablets to
treatment which aims to restore
try and prevent complications of
the normal valve at the lower end
acid reflux such as scarring of the
of the oesophagus which often
does not work properly in people
Surgery is usually reserved for
with Barrett's Oesophagus. This
people who do not respond well to
treatment is often carried out as a
lifestyle changes and drug therapy.
keyhole operation. You would onlyneed to stay in hospital for one or
two days, although it usually takes four weeks to recover
Treatments to prevent cancer
completely from the operation.
Since the vast majority of patients
Fundoplication surgery is
with Barrett's Oesophagus do not
successful in stopping acid reflux
get cancer, the usual practice in
in seven or eight of every ten
the United Kingdom is not to
people treated. It does have risks,
attempt to remove the Barrett's
so before agreeing to have surgery
cells. Treatment is usually only
it is important to discuss these
offered if the cells look as though
with the surgeon. Things which
they are starting to change and the
can trouble people after surgery
risk of getting cancer starts to rise.
include bloating of the abdomen,
Acid suppression and fundoplication
difficulty in swallowing and,
rarely, severe diarrhoea.
Although in theory, exposure to
acid and bile may make cells more
When to use which treatment
likely to turn cancerous, there is
Everyone with acid reflux should
no clear evidence that aggressive
try to make lifestyle changes.
suppression of acid reflux does
Often, simple changes to when
actually reduce the risk of cancer.
and what they eat will make
Decisions about these treatments
people feel very much better.
should generally be made on the basis of symptoms.
Many people will still need to take
drugs. People with frequent or
cent per year with half of all
This word is derived from the
patients developing cancer in
Greek meaning roughly "bad
around five years. This means
formation". It is used to describe
that half of these people will NOT
an abnormality within the tissue
develop cancer in five years. This
where the tissue changes and may
needs to influence your decision
in some cases progress to cancer.
about whether or not to have
Dysplasia is the earliest form of
pre-cancerous change that can be
All people with high grade
recognised and may be low grade
dysplasia should be referred to a
or high grade, the latter
specialist centre where their case
representing a more advanced
is discussed by a multi-disciplinary
progression towards cancer.
team of doctors and where the
Treatment for people with low grade
doctors perform minimally invasive
but complex treatments frequently.
All these treatments aim to
The risk of people with low grade
remove the dysplasia. In addition,
dysplasia getting cancer is only
they may aim to replace the red,
slightly higher than in people
Barrett's Oesophagus, with normal
without dysplasia. For this reason
pink (squamous) lining.
most doctors do not recommend treatment for this condition.
Barrx radiofrequency ablation
Most doctors would recommend
This is now the recommended
that you have check-ups with an
treatment for Barrett's with high
endoscopy every six months so that
grade dysplasia, and has replaced
they can monitor any changes in
major surgery (oesophagectomy)
the Barrett's cells. This is the
as the treatment of choice for
current guideline of the British
dysplasia. However, in a small
Society of Gastroenterology.
number of cases where early cancerous change has already
Treatment for people with high grade
occurred, resection may still be
necessary. It uses electrical
The risk of developing cancer is
current produced by radio waves
much higher for people with high
to destroy the dysplasia and is
grade dysplasia at about 10 per
performed during an endoscopy.
working to prevent cancer of the gullet
You will be given a sedative to
This treatment is usually repeated
make you sleepy. A probe will be
three or four times at intervals of
used to deliver the radio waves to
two to three months until not only
the affected parts. The procedure
the dysplasia, but also the entire
takes about 45 minutes.
Barrett's oesophagus has been removed.
Treating circumferential and/or long Barrett's using
Treating a small area of
a balloon catheter.
disease using a focal
Some people return to normal
immediately after treatment, most
After treatment patients have to
have mild pain easily controlled
continue regular surveillance as
with simple pain killers for a few
before, usually every 6 months
days; however, some may have
and then every year.
chest pain and nausea particularly
Although radiofrequency ablation
when they eat, for up to three
is safer and has fewer side effects
weeks after treatment. A very few
than major surgery, the
people (around 1 in 1100) suffer
disadvantage is that it involves
scarring of the oesophagus, but
many endoscopies and the need
this can normally be treated by
for continued surveillance.
Images above Copyright Covidien GI Solutions used by permission. The use of any
Barrx™ RF Ablation System photo or image does not imply Covidien review or
endorsement of any article or publication
Endoscopic Mucosal Resection
Mucosal resection does not aim to
Some patients with high grade
remove the Barrett's cells
dysplasia have a visible nodule in
completely; it cannot remove
their oesophagus. It is relatively
large sections of affected
straightforward to remove the
oesophagus without causing
nodule during endoscopy. The
scarring and difficulty in
procedure takes around 30-45
swallowing; however, usually
minutes and you can usually go
patients go on to have
home the same day. If you have
radiofrequency ablation to
this procedure you will be given a
complete treatment, as described
sedative to make you slightly
sleepy. Most people can eat and
Research is going on all the time
drink normally afterwards. In about
into new ways to treat Barrett's
one in ten people there may be
oesophagus. New studies are
minor bleeding, and more serious
being published regularly. Please
bleeding in one in 50 people.
speak to your specialist about the
Endoscopic mucosal resection is
current state of knowledge
a particularly useful test if the
regarding the treatments
diagnosis is not clear because the
removed nodule can be sent to
the laboratory to be checked by the pathologist. In this situation,
it serves as both a diagnostic test and a treatment. In a small
number of cases, histology may show that early cancerous change
has occurred, in which case, resection may be necessary.
working to prevent cancer of the gullet
The facts:In the UK:
400,000 to 1 million people are estimated to
have Barrett's Oesophagus.
At least 40,000 of these
can be expected to develop oesophageal cancerup to 32,000 can be expected to die within five
Founded as a charity in 1999, the Barrett's Oesophagus Campaign is the only national charity dedicated to the
prevention of cancer from Barrett's Oesophagus and the support of people living with the condition.
provide a support and education service to people who suffer from Barrett's Oesophagus and their relatives and
friendssupport research to better understand the condition
raise awareness to encourage early detection
If you would like to find out more about the Campaign's work, or the services they offer, please contact:
The Barrett's Oesophagus Campaign
UCL, Division of Durgery and Interventional ScienceRoyal Free and University College Medical School
Rowland Hill StreetLondon NW3 2PF
Tel: 020 7794 0500 Ext 23073
Registered Charity No. 1127495
Osteoporos IntDOI 10.1007/s00198-011-1528-y Skeletal mineralization defects in adulthypophosphatasia—a clinical and histological analysis F. Barvencik & F. Timo Beil & M. Gebauer & B. Busse &T. Koehne & S. Seitz & J. Zustin & P. Pogoda & T. Schinke &M. Amling Received: 14 April 2010 / Accepted: 3 January 2011 # International Osteoporosis Foundation and National Osteoporosis Foundation 2011
New Zealand Code of Practice for the Management of the Tomato/Potato Psyllid in Greenhouse Tomato and Capsicum Crops Published by: Tomatoes New Zealand and Vegetables New Zealand 2nd Edition4 October 2012 Table of ContentsTable of Contents . 21. Relevant legislation and industry standards. 3 Information on the tomato/potato psyllid. 3